Pub Date : 2024-07-15DOI: 10.1186/s13019-024-02862-0
Álvaro Ignacio Sánchez-Ortiz, Diego Peña-González, Alberto F García, Diego Fernando Bautista-Rincón, Carlos Alejandro García-González, Alejandro Moreno-Angarita, Astrid Carolina Álvarez-Ortega, Nicolas Felipe Torres-España, Eduardo Alberto Cadavid-Alvear, Mauricio Velásquez-Galvis
Background: Penetrating thoracic injuries have a significant risk of morbi-mortality. Despite the advancements in damage control methods, a subset of patients with severe pulmonary vascular lesions and bronchial injuries persists. In some of these cases, post-traumatic pneumonectomy is required, and perioperative extracorporeal membrane oxygenation (ECMO) support may be required due to right ventricular failure and respiratory failure.
Case description: A male was brought to the emergency department (ED) with a penetrating thoracic injury, presenting with massive right hemothorax and active bleeding that required ligation of the right pulmonary hilum to control the bleeding. Subsequently, he developed right ventricular dysfunction and ARDS, necessitating a dynamic hybrid ECMO configuration to support his condition and facilitate recovery.
Conclusions: Penetrating thoracic injuries with severe pulmonary vascular lesions may need pneumonectomy to control bleeding. ECMO support reduces the associated mortality by decreasing the complications rate. A multidisciplinary team is essential to achieve good outcomes in severe compromised patients.
{"title":"Pneumonectomy following penetrating trauma with ECMO as postoperative support: case report - (Lung trauma and ECMO).","authors":"Álvaro Ignacio Sánchez-Ortiz, Diego Peña-González, Alberto F García, Diego Fernando Bautista-Rincón, Carlos Alejandro García-González, Alejandro Moreno-Angarita, Astrid Carolina Álvarez-Ortega, Nicolas Felipe Torres-España, Eduardo Alberto Cadavid-Alvear, Mauricio Velásquez-Galvis","doi":"10.1186/s13019-024-02862-0","DOIUrl":"10.1186/s13019-024-02862-0","url":null,"abstract":"<p><strong>Background: </strong>Penetrating thoracic injuries have a significant risk of morbi-mortality. Despite the advancements in damage control methods, a subset of patients with severe pulmonary vascular lesions and bronchial injuries persists. In some of these cases, post-traumatic pneumonectomy is required, and perioperative extracorporeal membrane oxygenation (ECMO) support may be required due to right ventricular failure and respiratory failure.</p><p><strong>Case description: </strong>A male was brought to the emergency department (ED) with a penetrating thoracic injury, presenting with massive right hemothorax and active bleeding that required ligation of the right pulmonary hilum to control the bleeding. Subsequently, he developed right ventricular dysfunction and ARDS, necessitating a dynamic hybrid ECMO configuration to support his condition and facilitate recovery.</p><p><strong>Conclusions: </strong>Penetrating thoracic injuries with severe pulmonary vascular lesions may need pneumonectomy to control bleeding. ECMO support reduces the associated mortality by decreasing the complications rate. A multidisciplinary team is essential to achieve good outcomes in severe compromised patients.</p>","PeriodicalId":15201,"journal":{"name":"Journal of Cardiothoracic Surgery","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11247784/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141616494","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-15DOI: 10.1186/s13019-024-02907-4
Eitan Keizman, Tamer Jamal, Irena Sarantsev, Eilon Ram, Aryel Furman, Alexander Kogan, Ehud Raanani, Leonid Sternik
Background: The war that began on October 7th, 2023, has impacted all major tertiary medical centers in Israel. In the largest cardiac surgery department in Israel there has been a surprising increase in the number of open-heart procedures, despite having approximately 50% of surgeons recruited to military service. The purpose of this study is to characterize this increase in the number of operations performed during wartime and assess whether the national crisis has affected patient outcomes.
Methods: The study was based on a prospectively collected registry of 275 patients who underwent cardiac surgery or extracorporeal membrane oxygenation (ECMO) during the first two months of war, October 7th 2023 - December 7th 2023, as well as patients that underwent cardiac surgery during the same period of time in 2022 (October 7th, 2022 - December 7th, 2022).
Results: 120 patients (43.6%) were operated on in 2022, and 155 (56.4%) during wartime in 2023. This signifies a 33.0% increase in open-heart procedures (109 in 2022 vs. 145 in 2023, p-value 0.26). There were no significant differences in the baseline characteristics of patients when comparing the 2022 patients to those in 2023. No significant differences between the two groups were found with regards to intraoperative characteristics or the type of surgery. However, compared to 2022, there was a 233% increase in the number of transplantations in the 2023 cohort (p-value 0.24). Patient outcomes during wartime were similar to those of 2022, including postoperative complications, length of stay, and mortality.
Conclusions: Patients who underwent cardiac surgery during wartime presented with comparable outcomes when compared to those of last year despite the increase in cardiac surgery workload. There was an increase in the number of transplants this year, attributed to the unfortunate increase in organ donors.
{"title":"Cardiac surgery during wartime in Israel.","authors":"Eitan Keizman, Tamer Jamal, Irena Sarantsev, Eilon Ram, Aryel Furman, Alexander Kogan, Ehud Raanani, Leonid Sternik","doi":"10.1186/s13019-024-02907-4","DOIUrl":"10.1186/s13019-024-02907-4","url":null,"abstract":"<p><strong>Background: </strong>The war that began on October 7th, 2023, has impacted all major tertiary medical centers in Israel. In the largest cardiac surgery department in Israel there has been a surprising increase in the number of open-heart procedures, despite having approximately 50% of surgeons recruited to military service. The purpose of this study is to characterize this increase in the number of operations performed during wartime and assess whether the national crisis has affected patient outcomes.</p><p><strong>Methods: </strong>The study was based on a prospectively collected registry of 275 patients who underwent cardiac surgery or extracorporeal membrane oxygenation (ECMO) during the first two months of war, October 7th 2023 - December 7th 2023, as well as patients that underwent cardiac surgery during the same period of time in 2022 (October 7th, 2022 - December 7th, 2022).</p><p><strong>Results: </strong>120 patients (43.6%) were operated on in 2022, and 155 (56.4%) during wartime in 2023. This signifies a 33.0% increase in open-heart procedures (109 in 2022 vs. 145 in 2023, p-value 0.26). There were no significant differences in the baseline characteristics of patients when comparing the 2022 patients to those in 2023. No significant differences between the two groups were found with regards to intraoperative characteristics or the type of surgery. However, compared to 2022, there was a 233% increase in the number of transplantations in the 2023 cohort (p-value 0.24). Patient outcomes during wartime were similar to those of 2022, including postoperative complications, length of stay, and mortality.</p><p><strong>Conclusions: </strong>Patients who underwent cardiac surgery during wartime presented with comparable outcomes when compared to those of last year despite the increase in cardiac surgery workload. There was an increase in the number of transplants this year, attributed to the unfortunate increase in organ donors.</p>","PeriodicalId":15201,"journal":{"name":"Journal of Cardiothoracic Surgery","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11247751/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141616493","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Intrahepatic interruption of the inferior vena cava (IVC) with continued hemizygous is a very rare abnormality and sometimes it may be accompanied by other cardiovascular abnormalities. Continuation of the hemizygous vein draining into the right atrium through the left superior vena cava (LSVC) is much rarer. In this paper, we have presented a patient who had simultaneous IVC interrupted with persistent LSVC and suffered from Atrioventricular nodal reentrant tachycardia (AVNRT). Finally, radiofrequencies (RF) catheter ablation for AVNRT was successfully performed through a left subclavian vein access.
{"title":"RF catheter ablation of AVNRT in a patient with interrupted inferior vena cava anomaly with hemiazygos continuity with persistent left superior vena cava.","authors":"Ali Bozorgi, Faezeh Tabesh, Mansour Jahangiri, Parham Rabiei, Entezar Mehrabi Nasab","doi":"10.1186/s13019-024-02899-1","DOIUrl":"10.1186/s13019-024-02899-1","url":null,"abstract":"<p><p>Intrahepatic interruption of the inferior vena cava (IVC) with continued hemizygous is a very rare abnormality and sometimes it may be accompanied by other cardiovascular abnormalities. Continuation of the hemizygous vein draining into the right atrium through the left superior vena cava (LSVC) is much rarer. In this paper, we have presented a patient who had simultaneous IVC interrupted with persistent LSVC and suffered from Atrioventricular nodal reentrant tachycardia (AVNRT). Finally, radiofrequencies (RF) catheter ablation for AVNRT was successfully performed through a left subclavian vein access.</p>","PeriodicalId":15201,"journal":{"name":"Journal of Cardiothoracic Surgery","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11247846/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141616496","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-15DOI: 10.1186/s13019-024-02842-4
Soojin Lee, Juhyun Lee, Seohee Joo, You Kyeong Park, Kang Min Kim, Joon Chul Jung, Hyoung Woo Chang, Jae Hang Lee, Dong Jung Kim, Jun Sung Kim, Cheong Lim
Background: Owing to the lack of understanding of the clinical significance of pericardial calcification during pericardiectomy, whether pericardial calcification should be considered when determining the optimal timing for pericardiectomy is debatable. We aimed to investigate the effect of pericardial calcification on early postoperative outcomes in patients who underwent pericardiectomy for constrictive pericarditis.
Methods: Altogether, 44 patients who underwent pericardiectomy for constrictive pericarditis were enrolled. After excluding three patients who underwent concurrent surgeries, a total of 41 patients were categorized into two groups based on the presence of pericardial calcification as determined by preoperative computed tomography and pathological examination. Preoperative clinical and imaging characteristics, intraoperative data, and early postoperative outcomes were compared between the two groups. A multivariable analysis was performed to identify the factors associated with postoperative complications.
Results: The group with and without PC comprised 21 and 20 patients, respectively. No significant differences were observed in 30-day mortality (n = 1 [5%]) in the group with pericardial calcification and no mortality in the group without pericardial calcification (p > 0.999). Other early postoperative outcome variables did not demonstrate any significant differences between the two groups. However, the use of cardiopulmonary bypass was associated with postoperative complications (p < 0.009, odds ratio: 63.5, 95% confidence interval: 5.13-3400).
Conclusions: Pericardial calcification did not significantly affect the postoperative outcomes after pericardiectomy. Further comprehensive studies, including those with larger sample sizes and longitudinal designs, are necessary to determine whether pericardial calcification can significantly influence the timing of surgical intervention.
{"title":"Impact of pericardial calcification on early postoperative outcomes after pericardiectomy: a retrospective observational study.","authors":"Soojin Lee, Juhyun Lee, Seohee Joo, You Kyeong Park, Kang Min Kim, Joon Chul Jung, Hyoung Woo Chang, Jae Hang Lee, Dong Jung Kim, Jun Sung Kim, Cheong Lim","doi":"10.1186/s13019-024-02842-4","DOIUrl":"10.1186/s13019-024-02842-4","url":null,"abstract":"<p><strong>Background: </strong>Owing to the lack of understanding of the clinical significance of pericardial calcification during pericardiectomy, whether pericardial calcification should be considered when determining the optimal timing for pericardiectomy is debatable. We aimed to investigate the effect of pericardial calcification on early postoperative outcomes in patients who underwent pericardiectomy for constrictive pericarditis.</p><p><strong>Methods: </strong>Altogether, 44 patients who underwent pericardiectomy for constrictive pericarditis were enrolled. After excluding three patients who underwent concurrent surgeries, a total of 41 patients were categorized into two groups based on the presence of pericardial calcification as determined by preoperative computed tomography and pathological examination. Preoperative clinical and imaging characteristics, intraoperative data, and early postoperative outcomes were compared between the two groups. A multivariable analysis was performed to identify the factors associated with postoperative complications.</p><p><strong>Results: </strong>The group with and without PC comprised 21 and 20 patients, respectively. No significant differences were observed in 30-day mortality (n = 1 [5%]) in the group with pericardial calcification and no mortality in the group without pericardial calcification (p > 0.999). Other early postoperative outcome variables did not demonstrate any significant differences between the two groups. However, the use of cardiopulmonary bypass was associated with postoperative complications (p < 0.009, odds ratio: 63.5, 95% confidence interval: 5.13-3400).</p><p><strong>Conclusions: </strong>Pericardial calcification did not significantly affect the postoperative outcomes after pericardiectomy. Further comprehensive studies, including those with larger sample sizes and longitudinal designs, are necessary to determine whether pericardial calcification can significantly influence the timing of surgical intervention.</p>","PeriodicalId":15201,"journal":{"name":"Journal of Cardiothoracic Surgery","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11247834/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141620072","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-13DOI: 10.1186/s13019-024-02896-4
Harry Ramcharran, Ahmad Nazem
Background: An anomalous origin and inter-arterial course of the right coronary artery is a rare anomaly that can lead to sudden ischemic cardiac death if left untreated. We present a case of a patient with an anomalous right coronary artery originating from the left coronary sinus and an inter-arterial course that was managed with coronary artery bypass surgery using a suitable internal mammary artery conduit. The proximal right coronary artery was ligated to prevent competitive flow.
Case presentation: A 69 year-old-male with a ten-year history of intermittent chest pain and dyspnea with a negative workup underwent a cardiac catheterization, which showed an anomalous right coronary artery (RCA) originating from the left coronary sinus, with an inter-arterial course between the ascending aorta and pulmonary artery, and approximately 70% narrowing of the proximal RCA. The patient underwent an on-pump coronary artery bypass using the right internal mammary artery (RIMA) as a conduit, with segment 2 of the RCA being the target. The proximal RCA was ligated. Intra-operatively, there were no signs of ischemia or arrhythmia. The patient was successfully taken off cardiopulmonary bypass and eventually discharged home.
Conclusion: Symptomatic anomalous origin of the right coronary artery with an inter-arterial course can be treated successfully with coronary artery bypass surgery with the internal mammary artery as a conduit. Ligation of the proximal right coronary artery is essential to minimize competitive flow through the bypass graft.
{"title":"Anomalous right coronary artery managed with bypass and proximal ligation.","authors":"Harry Ramcharran, Ahmad Nazem","doi":"10.1186/s13019-024-02896-4","DOIUrl":"10.1186/s13019-024-02896-4","url":null,"abstract":"<p><strong>Background: </strong>An anomalous origin and inter-arterial course of the right coronary artery is a rare anomaly that can lead to sudden ischemic cardiac death if left untreated. We present a case of a patient with an anomalous right coronary artery originating from the left coronary sinus and an inter-arterial course that was managed with coronary artery bypass surgery using a suitable internal mammary artery conduit. The proximal right coronary artery was ligated to prevent competitive flow.</p><p><strong>Case presentation: </strong>A 69 year-old-male with a ten-year history of intermittent chest pain and dyspnea with a negative workup underwent a cardiac catheterization, which showed an anomalous right coronary artery (RCA) originating from the left coronary sinus, with an inter-arterial course between the ascending aorta and pulmonary artery, and approximately 70% narrowing of the proximal RCA. The patient underwent an on-pump coronary artery bypass using the right internal mammary artery (RIMA) as a conduit, with segment 2 of the RCA being the target. The proximal RCA was ligated. Intra-operatively, there were no signs of ischemia or arrhythmia. The patient was successfully taken off cardiopulmonary bypass and eventually discharged home.</p><p><strong>Conclusion: </strong>Symptomatic anomalous origin of the right coronary artery with an inter-arterial course can be treated successfully with coronary artery bypass surgery with the internal mammary artery as a conduit. Ligation of the proximal right coronary artery is essential to minimize competitive flow through the bypass graft.</p>","PeriodicalId":15201,"journal":{"name":"Journal of Cardiothoracic Surgery","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11245860/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141603632","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-13DOI: 10.1186/s13019-024-02950-1
Rachel Boyles, Joseph Lu, Joseph Yoo, Louis Samuels
Background: The COVID-19 pandemic was primarily considered a respiratory malady in the early phases of the outbreak. However, as more patients suffer from this illness, a myriad of symptoms emerge in organ systems separate from the lungs. Among those patients with cardiac involvement, myocarditis, pericarditis, myocardial infarction, and arrhythmia were among the most common manifestations. Pericarditis with pericardial effusion requiring medical or interventional treatments has been previously reported in the acute setting. Notably, chronic pericarditis with pericardial thickening resulting in constriction requiring sternotomy and pericardiectomy has not been published to date.
Case presentation: A patient with COVID-19-associated constrictive pericarditis three years after viral infection requiring pericardiectomy was reported. The COVID-19 infection originally manifested as anosmia and ageusia. Subsequently, the patient developed dyspnea, fatigue, right-sided chest pressure, bilateral leg edema, and abdominal fullness. Following recurrent right pleural effusions and a negative autoimmune work-up, the patient was referred for cardiothoracic surgery for pericardiectomy when radiographic imaging and hemodynamic assessment were consistent with constrictive pericarditis. Upon median sternotomy, the patient's pericardium was measured to be 8 mm thick. Descriptions of the clinical, diagnostic, and therapeutic features are provided. Within the first week after the operation, the patient's dyspnea resolved; one month later, leg edema and abdominal bloating were relieved.
Conclusions: Although an association between COVID-19 and cardiac complications has been established, this case adds another element of virus severity and chronic manifestations. The need for sternotomy and pericardiectomy to treat COVID-19-related constrictive pericarditis is believed to be the first reported diagnosis.
{"title":"COVID-related constrictive pericarditis requiring pericardiectomy: a case report.","authors":"Rachel Boyles, Joseph Lu, Joseph Yoo, Louis Samuels","doi":"10.1186/s13019-024-02950-1","DOIUrl":"10.1186/s13019-024-02950-1","url":null,"abstract":"<p><strong>Background: </strong>The COVID-19 pandemic was primarily considered a respiratory malady in the early phases of the outbreak. However, as more patients suffer from this illness, a myriad of symptoms emerge in organ systems separate from the lungs. Among those patients with cardiac involvement, myocarditis, pericarditis, myocardial infarction, and arrhythmia were among the most common manifestations. Pericarditis with pericardial effusion requiring medical or interventional treatments has been previously reported in the acute setting. Notably, chronic pericarditis with pericardial thickening resulting in constriction requiring sternotomy and pericardiectomy has not been published to date.</p><p><strong>Case presentation: </strong>A patient with COVID-19-associated constrictive pericarditis three years after viral infection requiring pericardiectomy was reported. The COVID-19 infection originally manifested as anosmia and ageusia. Subsequently, the patient developed dyspnea, fatigue, right-sided chest pressure, bilateral leg edema, and abdominal fullness. Following recurrent right pleural effusions and a negative autoimmune work-up, the patient was referred for cardiothoracic surgery for pericardiectomy when radiographic imaging and hemodynamic assessment were consistent with constrictive pericarditis. Upon median sternotomy, the patient's pericardium was measured to be 8 mm thick. Descriptions of the clinical, diagnostic, and therapeutic features are provided. Within the first week after the operation, the patient's dyspnea resolved; one month later, leg edema and abdominal bloating were relieved.</p><p><strong>Conclusions: </strong>Although an association between COVID-19 and cardiac complications has been established, this case adds another element of virus severity and chronic manifestations. The need for sternotomy and pericardiectomy to treat COVID-19-related constrictive pericarditis is believed to be the first reported diagnosis.</p>","PeriodicalId":15201,"journal":{"name":"Journal of Cardiothoracic Surgery","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11245867/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141603687","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-13DOI: 10.1186/s13019-024-02853-1
Soojin Lee, Joon Chul Jung, Hyoung Woo Chang, Jae Hang Lee, Dong Jung Kim, Jun Sung Kim, Cheong Lim
Background: This study examined the efficacy of del Nido cardioplegia compared with traditional blood cardioplegia in adult cardiac surgery for isolated coronary artery bypass grafting by evaluating the early postoperative outcomes.
Methods: A total of 119 patients who underwent isolated conventional coronary artery bypass grafting were enrolled and divided into two groups (del Nido cardioplegia group [n = 36] and blood cardioplegia group [n = 50]) based on the type of cardioplegia used. This study compared the preoperative characteristics, intraoperative data, and early postoperative outcomes. Further subgroup analyses were conducted for high-risk patient groups.
Results: The 30-day mortality and morbidity rates were not significantly different between groups. The del Nido cardioplegia group exhibited advantageous myocardial protection outcomes, demonstrated by a significantly smaller rise in Troponin I levels post-surgery (2.8 [-0.4; 4.2] vs. 4.5 [2.9; 7.4] ng/mL, p = 0.004) and fewer defibrillation attempts during weaning off of cardiopulmonary bypass (0.0 ± 0.2 vs. 0.4 ± 1.1 times, p = 0.011) when compared to the blood cardioplegia group. Additionally, the del Nido group achieved a reduction in surgery duration, as evidenced by the reduced aortic cross-clamping time (64.0 [55.5; 75.5] vs. 77.5 [65.0; 91.0] min, p = 0.001) and total operative time (287.5 [270.0; 305.0] vs. 315.0 [285.0; 365.0] min, p = 0.008). Subgroup analyses consistently demonstrated that the del Nido cardioplegia group had a significantly smaller postoperative increase in Troponin I levels across all subgroups (p < 0.05).
Conclusions: del Nido cardioplegia provided myocardial protection and favorable early postoperative outcomes compared to blood cardioplegia, making it a viable option for conventional coronary artery bypass grafting. Establishing a consensus on the protocol for Del Nido cardioplegia administration in adult surgeries is needed.
背景:本研究通过评估术后早期疗效,探讨了德尔尼多心脏麻痹与传统血液心脏麻痹在成人心脏手术分离冠状动脉旁路移植术中的疗效比较:方法:共招募了119名接受分离式常规冠状动脉旁路移植术的患者,并根据使用的心脏麻痹类型分为两组(德尔尼多心脏麻痹组[n = 36]和血液心脏麻痹组[n = 50])。本研究比较了两组患者的术前特征、术中数据和术后早期预后。对高风险患者组进行了进一步的亚组分析:结果:各组 30 天死亡率和发病率无明显差异。del Nido 强心剂组的心肌保护效果更佳,表现为术后肌钙蛋白 I 水平的上升幅度明显较小(2.8 [-0.4; 4.2] vs. 4.5 [2.9; 7.4]纳克/毫升,p = 0.004),而且与血液心脏麻痹组相比,在心肺旁路断流期间尝试除颤的次数更少(0.0 ± 0.2 vs. 0.4 ± 1.1 次,p = 0.011)。此外,del Nido 组缩短了手术时间,表现为缩短了主动脉交叉钳夹时间(64.0 [55.5; 75.5] 分钟 vs. 77.5 [65.0; 91.0] 分钟,p = 0.001)和总手术时间(287.5 [270.0; 305.0] 分钟 vs. 315.0 [285.0; 365.0] 分钟,p = 0.008)。亚组分析一致表明,在所有亚组中,德尔尼多心脏麻痹组术后肌钙蛋白 I 水平的升高明显较小(p 结论:与血液心脏麻痹相比,德尔尼多心脏麻痹可提供心肌保护和良好的术后早期预后,使其成为常规冠状动脉旁路移植术的可行选择。在成人手术中使用德尔尼多心脏麻痹的方案需要达成共识。
{"title":"Comparative analysis of del Nido cardioplegia versus blood cardioplegia in isolate coronary artery bypass grafting.","authors":"Soojin Lee, Joon Chul Jung, Hyoung Woo Chang, Jae Hang Lee, Dong Jung Kim, Jun Sung Kim, Cheong Lim","doi":"10.1186/s13019-024-02853-1","DOIUrl":"10.1186/s13019-024-02853-1","url":null,"abstract":"<p><strong>Background: </strong>This study examined the efficacy of del Nido cardioplegia compared with traditional blood cardioplegia in adult cardiac surgery for isolated coronary artery bypass grafting by evaluating the early postoperative outcomes.</p><p><strong>Methods: </strong>A total of 119 patients who underwent isolated conventional coronary artery bypass grafting were enrolled and divided into two groups (del Nido cardioplegia group [n = 36] and blood cardioplegia group [n = 50]) based on the type of cardioplegia used. This study compared the preoperative characteristics, intraoperative data, and early postoperative outcomes. Further subgroup analyses were conducted for high-risk patient groups.</p><p><strong>Results: </strong>The 30-day mortality and morbidity rates were not significantly different between groups. The del Nido cardioplegia group exhibited advantageous myocardial protection outcomes, demonstrated by a significantly smaller rise in Troponin I levels post-surgery (2.8 [-0.4; 4.2] vs. 4.5 [2.9; 7.4] ng/mL, p = 0.004) and fewer defibrillation attempts during weaning off of cardiopulmonary bypass (0.0 ± 0.2 vs. 0.4 ± 1.1 times, p = 0.011) when compared to the blood cardioplegia group. Additionally, the del Nido group achieved a reduction in surgery duration, as evidenced by the reduced aortic cross-clamping time (64.0 [55.5; 75.5] vs. 77.5 [65.0; 91.0] min, p = 0.001) and total operative time (287.5 [270.0; 305.0] vs. 315.0 [285.0; 365.0] min, p = 0.008). Subgroup analyses consistently demonstrated that the del Nido cardioplegia group had a significantly smaller postoperative increase in Troponin I levels across all subgroups (p < 0.05).</p><p><strong>Conclusions: </strong>del Nido cardioplegia provided myocardial protection and favorable early postoperative outcomes compared to blood cardioplegia, making it a viable option for conventional coronary artery bypass grafting. Establishing a consensus on the protocol for Del Nido cardioplegia administration in adult surgeries is needed.</p>","PeriodicalId":15201,"journal":{"name":"Journal of Cardiothoracic Surgery","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11245796/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141603633","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Extralobar pulmonary sequestration is located outside the lung parenchyma and is covered by a separated pleural sac, which comprises approximately 25% of all pulmonary sequestration.
Case presentation: This article reported one case of an extralobar pulmonary sequestration originated from the mesoesophagus, which was recognized and excised during a lung resection. Histologic examination revealed an ectopic lung tissue with hyperplasia of bronchioles, which was accord with an extralobar pulmonary sequestration.
Conclusions: CT angiogram, ultrasound and MRI can be used to clarify the diagnosis and detect the abnormal feeding arteries of extralobar pulmonary sequestration. Carefulness should be taken while dissecting and ligating the potential feeding arteries. Endovascular occlusion might be an alternative option to surgery.
{"title":"Recognition of an extralobar pulmonary sequestration during lung resection.","authors":"Ming Zhang, Weifen Tang, Hao Shi, Xiabin Tu, Weidong Li, Zhengliang Wei","doi":"10.1186/s13019-024-02880-y","DOIUrl":"10.1186/s13019-024-02880-y","url":null,"abstract":"<p><strong>Background: </strong>Extralobar pulmonary sequestration is located outside the lung parenchyma and is covered by a separated pleural sac, which comprises approximately 25% of all pulmonary sequestration.</p><p><strong>Case presentation: </strong>This article reported one case of an extralobar pulmonary sequestration originated from the mesoesophagus, which was recognized and excised during a lung resection. Histologic examination revealed an ectopic lung tissue with hyperplasia of bronchioles, which was accord with an extralobar pulmonary sequestration.</p><p><strong>Conclusions: </strong>CT angiogram, ultrasound and MRI can be used to clarify the diagnosis and detect the abnormal feeding arteries of extralobar pulmonary sequestration. Carefulness should be taken while dissecting and ligating the potential feeding arteries. Endovascular occlusion might be an alternative option to surgery.</p>","PeriodicalId":15201,"journal":{"name":"Journal of Cardiothoracic Surgery","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11245822/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141603690","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-13DOI: 10.1186/s13019-024-02826-4
Ye Liu, Jingjing Song, Siyu Wang, Lifeng Liu, Xiaoqing Liu, Zheng Liu, Yuxing Wang, Lei Zhao, Xinchun Yang
Objectives: This study aimed at exploring how using different kinds of sheaths will affect the very first ablation procedure of apprentices.
Methods: 15 patients with paroxysmal atrial fibrillation were randomized to used fixed-curve, conventional steerable or visualized steerable sheath, and received complete isolation of pulmonary veins. All ablations were the very first procedure performed by 15 ablation apprentices. The use of fluoroscopy and catheter stability during the PVI were analyzed.
Results: Procedure duration was much longer in the fixed-curve group (116.8 ± 27 vs. 62.2 ± 17 vs. 60.4 ± 17, p < 0.001). X-ray exposure was lowest with visualized sheath (17.6 ± 5 vs. 18.6 ± 6 vs. 5.2 ± 6, p < 0.001). CF SD differed significantly, especially at the anterior aspect of LSPV (7.90 ± 2.90 vs. 5.04 ± 2.18 vs. 4.52 ± 2.40, p < 0.001) and posterior aspect of RSPV (6.84 ± 2.79 vs. 3.42 ± 2.04 vs. 3.50 ± 2.30, p < 0.001) in the fixed-curve group. Impedance drop was significantly smaller in the fixed-curve group at the anterior aspect of LSPV (8.74 ± 3.02 vs. 11.49 ± 5.48 vs. 12.57 ± 5.96, p = 0.005).
Conclusion: Even for the very first ablation procedure of an ablation apprentice, the use of steerable sheaths will significantly reduce the procedure duration and improve the catheter stability, but only visualized steerable sheath can reduce fluoroscopic time.
研究目的方法:15 名阵发性心房颤动患者被随机分配使用固定曲线、传统可转向或可视化可转向鞘,并接受完全的肺静脉隔离。所有消融手术均由 15 名消融学徒首次实施。我们分析了 PVI 过程中透视的使用和导管的稳定性:结果:固定曲线组的手术时间更长(116.8 ± 27 vs. 62.2 ± 17 vs. 60.4 ± 17,P 结论:即使是首次消融手术,固定曲线组的手术时间也更长(116.8 ± 27 vs. 62.2 ± 17 vs. 60.4 ± 17,P 结论):即使是消融学徒的首次消融手术,使用可转向鞘管也能显著缩短手术时间并提高导管稳定性,但只有可视可转向鞘管才能缩短透视时间。
{"title":"Ablation apprentices and their first experience of pulmonary vein isolation procedure on paroxysmal atrial fibrillation with different sheaths.","authors":"Ye Liu, Jingjing Song, Siyu Wang, Lifeng Liu, Xiaoqing Liu, Zheng Liu, Yuxing Wang, Lei Zhao, Xinchun Yang","doi":"10.1186/s13019-024-02826-4","DOIUrl":"10.1186/s13019-024-02826-4","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed at exploring how using different kinds of sheaths will affect the very first ablation procedure of apprentices.</p><p><strong>Methods: </strong>15 patients with paroxysmal atrial fibrillation were randomized to used fixed-curve, conventional steerable or visualized steerable sheath, and received complete isolation of pulmonary veins. All ablations were the very first procedure performed by 15 ablation apprentices. The use of fluoroscopy and catheter stability during the PVI were analyzed.</p><p><strong>Results: </strong>Procedure duration was much longer in the fixed-curve group (116.8 ± 27 vs. 62.2 ± 17 vs. 60.4 ± 17, p < 0.001). X-ray exposure was lowest with visualized sheath (17.6 ± 5 vs. 18.6 ± 6 vs. 5.2 ± 6, p < 0.001). CF SD differed significantly, especially at the anterior aspect of LSPV (7.90 ± 2.90 vs. 5.04 ± 2.18 vs. 4.52 ± 2.40, p < 0.001) and posterior aspect of RSPV (6.84 ± 2.79 vs. 3.42 ± 2.04 vs. 3.50 ± 2.30, p < 0.001) in the fixed-curve group. Impedance drop was significantly smaller in the fixed-curve group at the anterior aspect of LSPV (8.74 ± 3.02 vs. 11.49 ± 5.48 vs. 12.57 ± 5.96, p = 0.005).</p><p><strong>Conclusion: </strong>Even for the very first ablation procedure of an ablation apprentice, the use of steerable sheaths will significantly reduce the procedure duration and improve the catheter stability, but only visualized steerable sheath can reduce fluoroscopic time.</p>","PeriodicalId":15201,"journal":{"name":"Journal of Cardiothoracic Surgery","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11245845/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141599923","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-13DOI: 10.1186/s13019-024-02969-4
Gang Chen, Yong Yu, Chengxing Qian, Yong Jiang, Jie Chen
Background: Minimally invasive treatments for spinal cord tumours are common. The aim of this study was to compare the perioperative outcomes of patients with thoracic extramedullary spinal tumours (TEST) treated by microendoscopic minimally invasive surgery-hemilaminectomy through a homemade tubular retractor (MIS-TR) and microscopic full laminectomy (open surgery).
Methods: Between February 2016 and February 2021, 51 patients with TEST were included. According to their clinical data, patients were classified into the MIS-TR group (n = 30) and the open surgery group (n = 21) and assessed.
Results: In both groups, the mean operation time, change in perioperative ASIA score, and modified Macnab score were comparable. The average postoperative hospital stay in the MIS-TR group was substantially shorter than that in the open surgery group (p < 0.0001). The mean blood loss volume in the MIS-TR group was substantially lower than that in the open surgery group (p = 0.001). The perioperative complication rate in the MIS-TR group was considerably lower than that in the open surgery group (p < 0.0001). At the 3-month follow-up, there was no substantial difference in the Oswestry Disability Index (ODI) score improvement between the two groups. Nonetheless, at the 12-month follow-up, the average ODI in the MIS-TR group was considerably lower than that in the open surgery group (p = 0.023). The main influencing factors for complete postoperative recovery were preoperative ASIA score (OR 7.848, P = 0.002), surgical complications (OR 0.017, P = 0.008) and age (OR 0.974, P = 0.393).
Conclusions: MIS-TR is safer and more effective than open surgery for treating TEST, but the long-term recovery of MIS-TR is not better than that of open surgery.
背景:脊髓肿瘤的微创治疗很常见。本研究旨在比较胸椎髓外脊柱肿瘤(TEST)患者接受微内镜微创手术--通过自制管状牵引器进行椎板切除术(MIS-TR)和显微镜下全椎板切除术(开放手术)治疗的围手术期疗效:方法:纳入2016年2月至2021年2月期间的51例TEST患者。根据患者的临床数据,将其分为MIS-TR组(30人)和开放手术组(21人)并进行评估:结果:两组患者的平均手术时间、围手术期 ASIA 评分变化和改良 Macnab 评分相当。MIS-TR 组的术后平均住院时间大大短于开放手术组(P 结论:MIS-TR 是一种更安全、更有效的手术方法:MIS-TR 在治疗 TEST 方面比开腹手术更安全、更有效,但 MIS-TR 的长期康复效果并不比开腹手术好。
{"title":"Comparison of microscopic full-laminectomy (open surgery) and microendoscopic minimally invasive hemilaminectomy for thoracic extramedullary spinal tumours.","authors":"Gang Chen, Yong Yu, Chengxing Qian, Yong Jiang, Jie Chen","doi":"10.1186/s13019-024-02969-4","DOIUrl":"10.1186/s13019-024-02969-4","url":null,"abstract":"<p><strong>Background: </strong>Minimally invasive treatments for spinal cord tumours are common. The aim of this study was to compare the perioperative outcomes of patients with thoracic extramedullary spinal tumours (TEST) treated by microendoscopic minimally invasive surgery-hemilaminectomy through a homemade tubular retractor (MIS-TR) and microscopic full laminectomy (open surgery).</p><p><strong>Methods: </strong>Between February 2016 and February 2021, 51 patients with TEST were included. According to their clinical data, patients were classified into the MIS-TR group (n = 30) and the open surgery group (n = 21) and assessed.</p><p><strong>Results: </strong>In both groups, the mean operation time, change in perioperative ASIA score, and modified Macnab score were comparable. The average postoperative hospital stay in the MIS-TR group was substantially shorter than that in the open surgery group (p < 0.0001). The mean blood loss volume in the MIS-TR group was substantially lower than that in the open surgery group (p = 0.001). The perioperative complication rate in the MIS-TR group was considerably lower than that in the open surgery group (p < 0.0001). At the 3-month follow-up, there was no substantial difference in the Oswestry Disability Index (ODI) score improvement between the two groups. Nonetheless, at the 12-month follow-up, the average ODI in the MIS-TR group was considerably lower than that in the open surgery group (p = 0.023). The main influencing factors for complete postoperative recovery were preoperative ASIA score (OR 7.848, P = 0.002), surgical complications (OR 0.017, P = 0.008) and age (OR 0.974, P = 0.393).</p><p><strong>Conclusions: </strong>MIS-TR is safer and more effective than open surgery for treating TEST, but the long-term recovery of MIS-TR is not better than that of open surgery.</p>","PeriodicalId":15201,"journal":{"name":"Journal of Cardiothoracic Surgery","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11245853/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141603686","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}