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Prophylactic 24 versus 48 h cephalosporins in cardiac surgery: A randomized trial. 心脏手术中 24 小时预防性头孢菌素与 48 小时预防性头孢菌素的比较:随机试验。
IF 0.7 Q3 Medicine Pub Date : 2024-11-10 DOI: 10.1177/02184923241297219
Mohammed Koudieh, Shukri Al Saif, Farouk Oueida, Abdulaziz Baradai, Khalid Alkhamees, Abdullah Otabi, Hatem Al Tahir, Hesham Younis, Ghada Al Qudaihi, Mostafa Essa, Tarek Maharem, Mostafa Fadel, Dina Al Balwai, Khalid Eskander

Background: Recommendations for cardiac surgery advocate for antibiotic prophylaxis for up to 48 hour after surgery. However, recent reports found a significant reduction in surgical site infection with extended duration. We evaluated the effect of the type of prophylactic antibiotics and administration durations on the postoperative surgical site infection rate following cardiac surgery in adults.

Methods: An investigator-initiated randomized controlled trial was conducted from 2018 to 2022 on adult patients undergoing cardiac surgery. Patients were randomized into four groups based on antibiotic treatment type and duration: 24 h cefazolin, 24 h cefuroxime, 48 h cefazolin, and 48 h cefuroxime. The primary outcome was the rate of surgical site infections within 90 days of surgery.

Results: A total of 568 patients were included in this study. The four groups had similar baseline characteristics, including age, sex, EuroSCORE II, and baseline HbA1c. A total of 75 patients developed infection within 90 days postoperative. The overall infection rate was not statistically different across the four groups (p = 0.193). The efficacy of cefazolin and cefuroxime in reducing infection was comparable (p = 0.901). Extended prophylaxis was associated with a significantly reduced overall infection rate within 90 days postoperatively compared to 24-h prophylaxis (10.2% vs. 16.3%; risk ratio = 0.62, 95% confidence interval: 0.40-0.96, p = 0.032).

Conclusion: Using cefazolin or cefuroxime for 48 h instead of 24 h was more effective in reducing the overall surgical site infections rate up to 90 days after surgery.

背景:心脏手术建议在术后 48 小时内使用抗生素预防。然而,最近的报告发现,延长用药时间可显著减少手术部位感染。我们评估了预防性抗生素的类型和用药时间对成人心脏手术后手术部位感染率的影响:2018年至2022年,研究者发起了一项随机对照试验,对象是接受心脏手术的成人患者。根据抗生素治疗类型和持续时间将患者随机分为四组:24 小时头孢唑啉、24 小时头孢呋辛、48 小时头孢唑啉和 48 小时头孢呋辛。主要结果是手术后 90 天内的手术部位感染率:本研究共纳入了 568 名患者。四组患者的基线特征相似,包括年龄、性别、EuroSCORE II 和基线 HbA1c。共有 75 名患者在术后 90 天内发生感染。四组的总体感染率无统计学差异(P = 0.193)。头孢唑啉和头孢呋辛在减少感染方面的疗效相当(p = 0.901)。与24小时预防相比,延长预防可显著降低术后90天内的总感染率(10.2%对16.3%;风险比=0.62,95%置信区间:0.40-0.96,p=0.032):结论:使用头孢唑啉或头孢呋辛 48 小时而不是 24 小时能更有效地降低术后 90 天内的手术部位感染率。
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引用次数: 0
Enlarging the surgeon's mind in aortic stenosis. 扩大外科医生对主动脉瓣狭窄的认识。
IF 0.7 Q3 Medicine Pub Date : 2024-11-08 DOI: 10.1177/02184923241296165
Arkalgud Sampath Kumar
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引用次数: 0
Accidental finding of ALCAPA in a child with severe mitral regurgitation: A case study. 一名患有严重二尖瓣返流的儿童意外发现 ALCAPA:病例研究。
IF 0.7 Q3 Medicine Pub Date : 2024-11-03 DOI: 10.1177/02184923241295550
Budi Rahmat, Radityo Prakoso, Rafles Ph Simbolon, Albert T Lopolisa, Muhammad Rayhan, Eva M Marwali

Case report: A six-year-old child who had undergone cardiac surgery five years ago presented to us with severe mitral valve regurgitation. During her current surgery, the coronary artery was injured during the attempt to release extensive epicardial adhesion, resulting in very poor contractility that prompted a delay in the intended valve repair. The injured coronary vessels were successfully repaired, yet low cardiac output syndrome persisted during perioperative care, necessitating further investigation of the coronary problem. It was later discovered that the patient had anomalous left coronary artery from pulmonary artery (ALCAPA) syndrome.

Discussion: The presence of severe mitral regurgitation, pulmonary hypertension, and anatomical factors may have contributed to the delayed presentation and diagnosis in this case. The severity of mitral regurgitation and the most likely underlying mechanism indicates a low possibility of recovery following coronary repair alone, warranting the need for concomitant mitral surgery. Coronary and mitral repair were performed in this patient, resulting in a favorable outcome.

Conclusions: The management of ALCAPA presents unique challenges, especially in cases with delayed diagnosis. Proper diagnosis and tailored surgical approaches are crucial for achieving favorable outcomes in patients with ALCAPA.

病例报告一名六岁儿童五年前曾接受过心脏手术,现因严重的二尖瓣返流来我院就诊。在目前的手术中,她的冠状动脉在试图松解广泛的心外膜粘连时受伤,导致收缩力极差,从而延误了预定的瓣膜修复手术。受伤的冠状动脉已成功修复,但围术期护理期间仍存在低心输出量综合征,因此有必要进一步检查冠状动脉问题。后来发现患者患有肺动脉左冠状动脉异常(ALCAPA)综合征:讨论:严重二尖瓣反流、肺动脉高压和解剖学因素可能是导致该病例延迟出现和诊断的原因。二尖瓣反流的严重程度和最可能的潜在机制表明,单靠冠状动脉修补术恢复的可能性很低,因此需要同时进行二尖瓣手术。该患者接受了冠状动脉和二尖瓣修复术,结果良好:结论:ALCAPA的治疗面临独特的挑战,尤其是在诊断延迟的病例中。正确的诊断和有针对性的手术方法是ALCAPA患者获得良好预后的关键。
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引用次数: 0
Coronary arteriovenous fistula originating from the left coronary artery and draining into the superior vena cava. 冠状动静脉瘘源自左冠状动脉,引流至上腔静脉。
IF 0.7 Q3 Medicine Pub Date : 2024-11-03 DOI: 10.1177/02184923241296166
Airi Kageyama, Takayuki Saito

Coronary arteriovenous fistulas are rare coronary anomalies. Most fistulas arise from the right coronary artery and drain into the right heart structures. We report a case of a 59-year-old man with a rare coronary arteriovenous fistula that originates from the left coronary artery and drains into the superior vena cava. He was diagnosed incidentally with cardiac computed tomography during the investigation for atrial fibrillation. Surgical fistula ligation was successfully performed under cardiac arrest with cardiopulmonary bypass. The patient was discharged without complications.

冠状动脉动静脉瘘是一种罕见的冠状动脉畸形。大多数瘘管来自右冠状动脉,并排入右心结构。我们报告了一例 59 岁男性罕见冠状动静脉瘘病例,该瘘源自左冠状动脉,引流至上腔静脉。他是在检查心房颤动时偶然通过心脏计算机断层扫描确诊的。在心搏停止和心肺旁路的情况下,成功进行了瘘管结扎手术。患者无并发症出院。
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引用次数: 0
Outcomes of fenestration versus none in extracardiac total cavopulmonary connection. 在心外全腔肺连接中进行瓣膜置入术与不进行瓣膜置入术的结果。
IF 0.7 Q3 Medicine Pub Date : 2024-10-23 DOI: 10.1177/02184923241292688
Noppon Taksaudom, Jakaparn Horsatidkul, Thitipong Tepsuwan, Apichat Tantraworasin, Rekwan Sittiwangkul, Amarit Phothikun

Background: Fenestrated total cavopulmonary connection has gained popularity due to its capacity to reduce systemic venous pressure and enhance cardiac output. However, there is ongoing debate about the immediate and long-term advantages of fenestration in this context.

Method: A retrospective cohort study was conducted involving 97 patients who underwent extracardiac total cavopulmonary connection at Chiang Mai University Hospital between January 1999 and December 2019. The patients were initially categorized into two groups: fenestrated (n = 71) and nonfenestrated (n = 26). After exclusion and reassignment, the long-term outcomes were analyzed for the fenestrated (n = 68) and nonfenestrated (n = 25) groups. To address potential confounding factors between the two groups, propensity scores were computed using logistic regression analysis.

Results: The study found no significant differences in preoperative and operative data. Immediate postoperative outcomes showed no significant variations in major complications, intensive care unit stay, oxygen saturation, and posttotal cavopulmonary connection pressure. In the long-term assessment, the fenestrated group demonstrated significantly lower rates of mortality, protein-losing enteropathy, liver mass, and cirrhosis. However, after employing a multilevel model stratified by propensity score analysis, only long-term mortality rate was significantly lower in the fenestrated group (hazard ratio = 0.12, 95% confidence interval = 0.02-0.97). Fenestration patency closed gradually through spontaneous closure and device intervention.

Conclusion: The study found no major differences in immediate postoperative outcomes. In the fenestrated cohort, significantly lower incidences of protein-losing enteropathy, liver mass, cirrhosis, and long-term mortality were observed. However, multilevel model stratified by propensity score analysis indicated that only the lower long-term mortality demonstrated a major effect.

背景:瓣膜全腔肺连接术因其能降低全身静脉压和提高心输出量而受到欢迎。然而,在这种情况下,关于瓣膜的近期和远期优势一直存在争议:一项回顾性队列研究涉及 1999 年 1 月至 2019 年 12 月期间在清迈大学医院接受心外全腔肺连接术的 97 名患者。这些患者最初被分为两组:有瘘管(71 人)和无瘘管(26 人)。在排除和重新分配后,对开窗组(n = 68)和非开窗组(n = 25)的长期结果进行了分析。为了解决两组之间潜在的混杂因素,研究人员使用逻辑回归分析法计算了倾向得分:研究发现,术前和手术数据无明显差异。术后近期结果显示,主要并发症、重症监护室住院时间、血氧饱和度和全腔肺连接后压力均无明显差异。在长期评估中,栅栏组的死亡率、蛋白丢失性肠病、肝脏肿块和肝硬化的发生率明显较低。然而,在采用倾向得分分析多层次模型分层后,只有瓣膜组的长期死亡率明显降低(危险比 = 0.12,95% 置信区间 = 0.02-0.97)。通过自发闭合和设备干预,瘘管通畅率逐渐关闭:结论:研究发现,术后即刻结果没有重大差异。结论:研究发现术后即刻预后无重大差异,但在瘘管队列中,蛋白质丢失性肠病、肝脏肿块、肝硬化和长期死亡率的发生率明显较低。然而,根据倾向得分分析建立的多层次分层模型表明,只有长期死亡率较低才显示出主要影响。
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引用次数: 0
Impact of preoperative computed tomography scan on neurological outcomes in coronary artery bypass grafting patients: A propensity-score analysis. 术前计算机断层扫描对冠状动脉旁路移植术患者神经系统预后的影响:倾向分数分析
IF 0.7 Q3 Medicine Pub Date : 2024-10-21 DOI: 10.1177/02184923241292098
Mariano Cefarelli, Pietro Giorgio Malvindi, Olimpia Bifulco, Beatrice Buratto, Paolo Berretta, Carlo Zingaro, Filippo Capestro, Michele Danilo Pierri, Jacopo Alfonsi, Alessandro D'Alfonso, Marco Di Eusanio

Introduction: Neurological complications pose significant risks in coronary artery bypass grafting (CABG). This study explores the potential benefits of preoperative chest computed tomography (CT) in optimizing outcomes and reducing neurological events in high-risk CABG patients.

Methods: From January 2017 to June 2023, a retrospective cohort study of CABG patients categorized groups based on preoperative chest CT use. Multivariate analysis evaluated the associations between CT imaging and patient characteristics, followed by propensity match analysis to balance preoperative features across groups.

Results: The study included 1786 patients, with 435 having undergone preoperative CT and 1351 without. Propensity matching created two well-balanced groups of 413 patients each. At multivariate analysis, CT patients were elderly (71.1 ± 8.9 years; p = 0.03) with a higher incidence of pulmonary disease (19.5%; p < 0.01), peripheral arterial disease (29.2%; p < 0.01), and previous cerebrovascular disease (23.4%; p = 0.02). In the matched CT cohort, the perioperative cerebral stroke rate was 0.7% (vs. 1.9% in without preoperative CT [WCT] cohort; p = 0.223), and the 30-day mortality rate was 0.2% (vs. 1.7% in WCT cohort; p = 0.069). Patients who had a preoperative CT study presented a higher prevalence of porcelain aorta (6.3% vs. 1.5%; p = 0.0003) and required more often a no-touch aorta procedure (20.3% vs. 14.5%; p = 0.035).

Conclusions: Patients undergoing preoperative chest CT before CABG were typically older and had systemic atherosclerosis and pulmonary disease. Propensity-matched analysis indicated low mortality and perioperative cerebral stroke rates in these high-risk patients. These findings support the integration of chest CT into preoperative evaluations for high-risk patients to develop tailored strategies in coronary artery bypass surgery.

导言:神经系统并发症是冠状动脉旁路移植术(CABG)的重大风险。本研究探讨了术前胸部计算机断层扫描(CT)在优化高风险 CABG 患者预后和减少神经系统事件方面的潜在益处:从 2017 年 1 月到 2023 年 6 月,一项对 CABG 患者的回顾性队列研究根据术前胸部 CT 的使用情况进行了分组。多变量分析评估了CT成像与患者特征之间的关联,然后进行倾向匹配分析,以平衡各组患者的术前特征:该研究共纳入了 1786 名患者,其中 435 人接受了术前 CT 检查,1351 人未接受术前 CT 检查。倾向匹配产生了两组均衡的患者,每组 413 人。多变量分析显示,CT 患者年龄较大(71.1 ± 8.9 岁;P = 0.03),肺部疾病发病率较高(19.5%;P = 0.02)。在匹配的 CT 队列中,围手术期脑卒中发生率为 0.7%(与未进行术前 CT [WCT] 队列中的 1.9%相比;P = 0.223),30 天死亡率为 0.2%(与 WCT 队列中的 1.7%相比;P = 0.069)。接受术前 CT 检查的患者主动脉瓷化的发生率更高(6.3% 对 1.5%;P = 0.0003),需要进行无触点主动脉手术的比例更高(20.3% 对 14.5%;P = 0.035):结论:接受 CABG 术前胸部 CT 的患者通常年龄较大,患有全身动脉粥样硬化和肺部疾病。倾向匹配分析表明,这些高危患者的死亡率和围手术期脑卒中发生率较低。这些研究结果支持将胸部 CT 纳入高危患者的术前评估,以便为冠状动脉搭桥手术制定有针对性的策略。
{"title":"Impact of preoperative computed tomography scan on neurological outcomes in coronary artery bypass grafting patients: A propensity-score analysis.","authors":"Mariano Cefarelli, Pietro Giorgio Malvindi, Olimpia Bifulco, Beatrice Buratto, Paolo Berretta, Carlo Zingaro, Filippo Capestro, Michele Danilo Pierri, Jacopo Alfonsi, Alessandro D'Alfonso, Marco Di Eusanio","doi":"10.1177/02184923241292098","DOIUrl":"https://doi.org/10.1177/02184923241292098","url":null,"abstract":"<p><strong>Introduction: </strong>Neurological complications pose significant risks in coronary artery bypass grafting (CABG). This study explores the potential benefits of preoperative chest computed tomography (CT) in optimizing outcomes and reducing neurological events in high-risk CABG patients.</p><p><strong>Methods: </strong>From January 2017 to June 2023, a retrospective cohort study of CABG patients categorized groups based on preoperative chest CT use. Multivariate analysis evaluated the associations between CT imaging and patient characteristics, followed by propensity match analysis to balance preoperative features across groups.</p><p><strong>Results: </strong>The study included 1786 patients, with 435 having undergone preoperative CT and 1351 without. Propensity matching created two well-balanced groups of 413 patients each. At multivariate analysis, CT patients were elderly (71.1 ± 8.9 years; <i>p </i>= 0.03) with a higher incidence of pulmonary disease (19.5%; <i>p </i>< 0.01), peripheral arterial disease (29.2%; <i>p </i>< 0.01), and previous cerebrovascular disease (23.4%; <i>p </i>= 0.02). In the matched CT cohort, the perioperative cerebral stroke rate was 0.7% (vs. 1.9% in without preoperative CT [WCT] cohort; <i>p </i>= 0.223), and the 30-day mortality rate was 0.2% (vs. 1.7% in WCT cohort; <i>p </i>= 0.069). Patients who had a preoperative CT study presented a higher prevalence of porcelain aorta (6.3% vs. 1.5%; <i>p </i>= 0.0003) and required more often a no-touch aorta procedure (20.3% vs. 14.5%; <i>p </i>= 0.035).</p><p><strong>Conclusions: </strong>Patients undergoing preoperative chest CT before CABG were typically older and had systemic atherosclerosis and pulmonary disease. Propensity-matched analysis indicated low mortality and perioperative cerebral stroke rates in these high-risk patients. These findings support the integration of chest CT into preoperative evaluations for high-risk patients to develop tailored strategies in coronary artery bypass surgery.</p>","PeriodicalId":35950,"journal":{"name":"ASIAN CARDIOVASCULAR & THORACIC ANNALS","volume":" ","pages":"2184923241292098"},"PeriodicalIF":0.7,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142476630","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Successful repair of infracardiac total anomalous pulmonary venous connection with nonconfluent bilateral pulmonary veins. 双侧肺静脉不汇合的心下全肺静脉连接异常修复手术获得成功。
IF 0.7 Q3 Medicine Pub Date : 2024-10-17 DOI: 10.1177/02184923241291917
Tomonori Ochiai, Hideki Tatewaki, Naoki Masaki, Sadahiro Sai

We report a rare case of an infracardiac-type total anomalous pulmonary venous connection with nonconfluent bilateral pulmonary veins in a patient diagnosed with heterotaxy syndrome with right atrial isomerism, mitral valve atresia, a single atrium, and double-outlet right ventricle. On the fourth day of life, the patient underwent successful repair using a sutureless technique. Two years after the surgery, the patient remained well without any signs of pulmonary venous obstruction.

我们报告了一例罕见的心下型全肺静脉连接异常和双侧肺静脉非汇合病例,患者被诊断为异位发育综合征,伴有右心房异位、二尖瓣闭锁、单心房和右心室双出口。患者出生后第四天,成功接受了无缝合技术修复手术。术后两年,患者的情况依然良好,没有任何肺静脉阻塞的迹象。
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引用次数: 0
Pulmonary metastasectomy after immune checkpoint inhibitors in malignant melanoma. 恶性黑色素瘤患者使用免疫检查点抑制剂后的肺转移切除术
IF 0.7 Q3 Medicine Pub Date : 2024-09-01 Epub Date: 2024-03-25 DOI: 10.1177/02184923241241583
Ichiro Sakanoue, Masatsugu Hamaji, Akihiro Ohsumi, Daisuke Nakajima, Hiroshi Date

The management of malignant melanoma with pulmonary metastases is controversial and occasionally requires multimodality management, including pulmonary metastasectomy after immune checkpoint inhibitors (ICIs). However, limited data are available on these patients. We described a case series of three consecutive patients who underwent pulmonary metastasectomy after ICIs for malignant melanoma and discussed the important characteristics of these patients. After pulmonary metastasectomy, none of the patients had recurrent pulmonary metastases, although extrapulmonary metastases were developed. Our case series suggests that pulmonary metastasectomy after ICIs may control pulmonary metastases in carefully selected patients with malignant melanoma.

恶性黑色素瘤肺转移的治疗存在争议,有时需要多模式治疗,包括使用免疫检查点抑制剂(ICIs)后进行肺转移灶切除术。然而,有关这些患者的数据十分有限。我们描述了三例连续接受肺转移切除术的恶性黑色素瘤 ICIs 患者的病例系列,并讨论了这些患者的重要特征。肺转移灶切除术后,虽然出现了肺外转移,但没有一名患者出现复发性肺转移。我们的病例系列表明,对经过严格筛选的恶性黑色素瘤患者进行 ICI 后肺转移灶切除术可控制肺转移。
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引用次数: 0
Total arterial revascularization with RIMA-LIMA-Y configuration in patients with left subclavian artery stenosis. 在左锁骨下动脉狭窄患者中使用 RIMA-LIMA-Y 配置进行全动脉再血管化。
IF 0.7 Q3 Medicine Pub Date : 2024-09-01 Epub Date: 2024-11-03 DOI: 10.1177/02184923241284318
Anit Kumar, Bharath Sundar, Swanand Khapli, Sayyed Azhar Salim Ahmed, Dhiraj Barman, Lalit Kapoor, Unmesh Chakraborty

Background: Subclavian artery stenosis (SAS) occurs in 6% of patients undergoing coronary artery bypass grafting (CABG). Complications such as subclavian-coronary steal are common. Revascularization options in such cases remain debatable.

Methods: In this case series, all patients with angina, had severe triple vessel disease on angiography. All tests including computed tomography (CT) angiography of neck vessels, were done as part of routine workup for CABG.

Results: The patients, all males, had a mean age of 66.5 years with three of them having hypertension and diabetes. All were ex-smokers with mean ejection fraction (EF) of 60.1%. CT angiography of neck vessels revealed that two patients had moderate to severe while one had severe left SAS and another had severe proximal left internal mammary artery (LIMA) stenosis. Total arterial revascularization was performed, with an average of 3.5 distal grafts. The LIMA graft was employed in a Y graft configuration, anastomosed to in-situ right internal mammary artery (RIMA). All patients had uneventful postoperative stay and were discharged with a mean hospital stay of 3.8 days. There were no postoperative strokes, myocardial infarction, neurological symptoms, or change in EF. At 6-month follow-up, they were asymptomatic and doing well.

Conclusion: The RIMA-LIMA-Y configuration can be a safe, viable option in CABG for patients with left SAS. It is challenging, with re-entry and judicious utilization of the length of LIMA being of paramount importance. The importance of CT angiography of neck vessels to detect SAS cannot be under-emphasized.

背景:接受冠状动脉旁路移植术(CABG)的患者中,有 6% 会出现锁骨下动脉狭窄(SAS)。锁骨下-冠状动脉盗血等并发症很常见。此类病例的血管重建方案仍有争议:在本病例系列中,所有心绞痛患者在血管造影检查中都有严重的三支血管病变。所有检查包括颈部血管的计算机断层扫描(CT)血管造影术,都是作为 CABG 常规检查的一部分进行的:患者均为男性,平均年龄为 66.5 岁,其中三人患有高血压和糖尿病。所有患者均已戒烟,平均射血分数(EF)为 60.1%。颈部血管 CT 血管造影显示,两名患者患有中度至重度狭窄,一名患者患有重度左侧 SAS 狭窄,另一名患者患有重度左侧乳内动脉 (LIMA) 近端狭窄。患者接受了全动脉血管再造术,平均移植了 3.5 条远端动脉。LIMA 移植采用 Y 型结构,与原位右乳内动脉 (RIMA) 吻合。所有患者术后均顺利出院,平均住院时间为 3.8 天。术后未发生中风、心肌梗死、神经症状或 EF 变化。随访6个月时,他们均无症状,情况良好:结论:RIMA-LIMA-Y配置是左侧SAS患者进行CABG的一种安全可行的选择。它具有挑战性,再次入路和合理利用 LIMA 长度至关重要。颈部血管 CT 血管造影对检测 SAS 的重要性不容忽视。
{"title":"Total arterial revascularization with RIMA-LIMA-Y configuration in patients with left subclavian artery stenosis.","authors":"Anit Kumar, Bharath Sundar, Swanand Khapli, Sayyed Azhar Salim Ahmed, Dhiraj Barman, Lalit Kapoor, Unmesh Chakraborty","doi":"10.1177/02184923241284318","DOIUrl":"10.1177/02184923241284318","url":null,"abstract":"<p><strong>Background: </strong>Subclavian artery stenosis (SAS) occurs in 6% of patients undergoing coronary artery bypass grafting (CABG). Complications such as subclavian-coronary steal are common. Revascularization options in such cases remain debatable.</p><p><strong>Methods: </strong>In this case series, all patients with angina, had severe triple vessel disease on angiography. All tests including computed tomography (CT) angiography of neck vessels, were done as part of routine workup for CABG.</p><p><strong>Results: </strong>The patients, all males, had a mean age of 66.5 years with three of them having hypertension and diabetes. All were ex-smokers with mean ejection fraction (EF) of 60.1%. CT angiography of neck vessels revealed that two patients had moderate to severe while one had severe left SAS and another had severe proximal left internal mammary artery (LIMA) stenosis. Total arterial revascularization was performed, with an average of 3.5 distal grafts. The LIMA graft was employed in a Y graft configuration, anastomosed to in-situ right internal mammary artery (RIMA). All patients had uneventful postoperative stay and were discharged with a mean hospital stay of 3.8 days. There were no postoperative strokes, myocardial infarction, neurological symptoms, or change in EF. At 6-month follow-up, they were asymptomatic and doing well.</p><p><strong>Conclusion: </strong>The RIMA-LIMA-Y configuration can be a safe, viable option in CABG for patients with left SAS. It is challenging, with re-entry and judicious utilization of the length of LIMA being of paramount importance. The importance of CT angiography of neck vessels to detect SAS cannot be under-emphasized.</p>","PeriodicalId":35950,"journal":{"name":"ASIAN CARDIOVASCULAR & THORACIC ANNALS","volume":" ","pages":"395-399"},"PeriodicalIF":0.7,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142569527","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Outcomes of advanced EVAR versus open surgery in the management of complex abdominal aortic aneurysm repair: A systematic review and meta-analysis. 在复杂腹主动脉瘤修补术中,高级 EVAR 与开放手术的疗效对比:系统回顾和荟萃分析。
IF 0.7 Q3 Medicine Pub Date : 2024-09-01 Epub Date: 2024-06-17 DOI: 10.1177/02184923241262847
Putu Febry Krisna Pertiwi, I Wayan Sudarma, Gusti Ngurah Prana Jagannatha, Anastasya Maria Kosasih, Cokorda Istri Dyah Yustika Dewi, I Gusti Agung Angga Wijaya

Background: Open surgery is still acknowledged as the gold standard for complex abdominal aortic aneurysm (c-AAA). Recently, advanced-endovascular aortic aneurysm repair (EVAR) for c-AAA has been developed, but its effectiveness compared to open surgery is still unclear.

Method: A systematic search was performed on the MEDLINE through PubMed and ScienceDirect databases. The search was aimed to investigate outcomes of both fenestrated- and chimney-EVAR (consider as advanced EVAR) compared to open surgery in c-AAA. Outcomes included postoperative complications, 30-day mortality, long-term mortality, and reintervention rate. Data were collected using the Mantel-Haenszel fixed effects model with relative risk (RR) as the effect size with 95% confidence interval (CI).

Results: A total of 25 studies (n = 12,845 patients) were included in our study. The results demonstrated that advanced-EVAR correlated with diminished postoperative complications (RR 0.53; 95% CI 0.49-0.57; p < 0.001) compared to open surgery. Advanced-EVAR was associated with lower 30-day mortality compared to open surgery (RR 0.66; 95% CI 0.53-0.82; p < 0.001). Subgroup analysis revealed that fenestrated-EVAR resulted in superior outcomes (p < 0.001), whereas the chimney-EVAR subgroup did not show significant differences (p = 0.79), compared to open surgery in terms of 30-day mortality. Unfortunately, advanced-EVAR was associated with a higher long-term mortality rate (RR 1.46; 95% CI 1.20-1.78; p < 0.001) and a higher reintervention rate (RR 1.26; 95% CI 1.01-1.59; p = 0.04) compared to open surgery.

Conclusion: Advanced EVAR, especially fenestrated-EVAR, presented better short-term outcomes compared to open surgery; however, it failed to demonstrate superiority over open surgery in improving long-term outcomes.

背景:开腹手术仍被公认为治疗复杂腹主动脉瘤(c-AAA)的金标准。最近,针对 c-AAA 的先进血管内主动脉瘤修补术(EVAR)得到了发展,但与开放手术相比,其有效性仍不明确:方法:通过 PubMed 和 ScienceDirect 数据库对 MEDLINE 进行了系统性检索。方法:通过PubMedline和ScienceDirect数据库对MEDLINE进行了系统性检索,旨在研究与开腹手术相比,栅栏式EVAR和烟囱式EVAR(被认为是高级EVAR)对c-AAA的治疗效果。结果包括术后并发症、30 天死亡率、长期死亡率和再介入率。数据收集采用Mantel-Haenszel固定效应模型,以相对风险(RR)作为效应大小和95%置信区间(CI):我们的研究共纳入了 25 项研究(n = 12,845 例患者)。结果表明,就 30 天死亡率而言,与开放手术相比,晚期 EVAR 可减少术后并发症(RR 0.53;95% CI 0.49-0.57;p p p p = 0.79)。遗憾的是,与开腹手术相比,晚期EVAR的长期死亡率更高(RR 1.46;95% CI 1.20-1.78;P P = 0.04):结论:先进的EVAR,尤其是栅栏式EVAR,与开腹手术相比,短期疗效更好;但在改善长期疗效方面,先进的EVAR未能显示出优于开腹手术。
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