ASIAN CARDIOVASCULAR & THORACIC ANNALS最新文献

BackgroundThe optimal cerebral protection strategy during complex aortic surgery remains controversial, and various brain monitoring modalities are used to provide different information to improve cerebral protection. This study aims to compare the effect of the change in cerebral oxygen saturation during hypothermic circulatory arrest on the early postoperative neurological outcome in antegrade cerebral perfusion (ACP) versus retrograde cerebral perfusion (RCP) during circulatory arrest in adult aortic surgery using cerebral oximetry.MethodsThis was a cross-sectional analytic study that enrolled a total of 84 patients undergoing total circulatory arrest during adult aortic surgery divided into two groups. Group A: 42 cases undergoing selective ACP; Group B: 42 cases undergoing RCP.ResultsCerebral oxygen saturation before and after circulatory arrest (right and left), cerebral oxygen saturation after cardiopulmonary bypass (right and left) and cross clamp time were significantly lower in Group A than Group B. Cerebral oxygen saturation during circulatory arrest (right and left) and circulatory arrest time were significantly higher in Group A than Group B. Regaining of conscious level time, mechanical ventilation time, neurological dysfunction, other organs dysfunction, and mortality were significantly lower in Group A than Group B.ConclusionsDuring hypothermic circulatory arrest in complex aortic surgery in adults, cerebral oxygen saturation was an independent predictor of neurological dysfunction in patients who underwent RCP and in patients who underwent ACP.

BackgroundMalignant pleural effusion is characterized by the presence of malignant cells in the pleural fluid. Malignant cells from pleural lavage performed in patients without a coexistent pleural effusion have been identified as an indicator of micrometastatic disease and are associated with a higher recurrence rate and poorer survival. The aim of this study was to evaluate the efficacy and safety of the short-term postoperative outcomes with patients who underwent awake and intubated video-assisted thoracoscopic surgery (VATS) in the management of recurrent malignant pleural effusion. We hypothesized that nonintubated VATS is as safe and effective as intubated VATS for MPE management.MethodsA case series of 315 consecutive patients from January 2021 to November 2023 with malignant pleural effusion. The patients were randomized into two groups as nonintubated video-assisted thoracoscopic Pleurodesis with sedoanalgesia (nonintubated as group A) and video-assisted thoracoscopic pleurodesis with general anesthesia (intubated as group B).ResultsThe study included 315 patients who underwent video-assisted thoracoscopic pleurodesis either intubated or not. The mean average age was noted to be 54.58 ± 7.93. There were 178 cases of male patients (65.5%). Visual analogue score showed a significant difference after procedure 4 h without any difference after 24 h. There was a nonsignificant difference between both groups according to changes in dyspnea score and grades of chest X-ray findings of pleural effusion.ConclusionsNonintubated VATS is safe in patients, especially those with comorbidity who couldn't tolerate general anesthesia. It has also similar reliability compared to VATS performed under general anesthesia.

We present an adult case of iatrogenic aorto-right ventricular fistula that developed after percutaneous transcatheter pulmonary valvuloplasty for pulmonary valve stenosis using Mustang® double balloons following definitive repair of double outlet right ventricle. At outpatient follow-up, an abnormal shunt between the aortic root and the right ventricular outflow tract was detected by echocardiography and enhanced computed tomography. The ratio of pulmonic to systemic blood flow was measured at 1.64 by cardiac catheterization. We successfully performed patch closure of the aorto-right ventricular fistula, concomitant with pulmonary valve replacement and tricuspid valvuloplasty.

BackgroundCoarctation of the aorta (CoA) is a congenital condition that often requires intervention, especially when associated with other intracardiac abnormalities. Surgical approaches to treat complex CoA and associated defects vary, with no universally accepted standard approach. This study evaluates the outcomes of a single-stage extra-anatomic bypass from the ascending to the descending thoracic aorta, along with simultaneous correction of associated intracardiac abnormalities in adult patients.MethodsWe conducted a retrospective analysis of 17 adult patients who underwent a single-stage extra-anatomic bypass for complex CoA repair between January 2014 and December 2023. Patients were treated with an ascending to descending thoracic aorta bypass via a right-sided extra-anatomic approach, with simultaneous correction of associated cardiac defects. The primary outcomes measured were perioperative mortality, haemodynamic improvement, and post-operative complications.ResultsThe mean age of patients was 35.9 years. The single-stage repair showed a 94.1% survival rate, with significant haemodynamic improvement indicated by a reduction in blood pressure gradient from 49.7 ± 7.4 mmHg pre-operatively to 11.2 ± 3.9 mmHg post-operatively. There were minimal complications, with no evidence of graft failure, kinking, or cerebrovascular incidents during follow-up. One patient experienced acute kidney injury and early mortality. Follow-up of up to 10 years demonstrated durable results with favourable outcomes.ConclusionThe single-stage extra-anatomic bypass with simultaneous correction of associated cardiac defects is a safe and effective approach for managing complex CoA in adults.

The introduction of the neonatal arterial switch operation in the 1980s demonstrated that early repair of congenital heart anomalies could be performed with improved patient survival relative to initial palliation and delayed repair in later infancy or beyond. Over the next decade or two, there was a continuing move away from a staged approach at most congenital heart programs. Studies from that era documented that the staged approach increased overall cost and reduced ultimate patient survival. However, over the last decade or two, there has been resurgent popularity of a staged approach, particularly for the management of very small and premature newborns. This paper reviews the factors that have led to increasing enthusiasm for the staged approach to management of congenital heart disease. The danger of using procedural databases like the Society for Thoracic Surgery (STS) and European Association for Cardiothoracic Surgery (EACTS) surgical databases to measure the quality of overall patient management strategy is emphasized. Until diagnosis-based, patient survival databases are used for Quality Assurance, it will not be possible to define whether a tipping point exists, below which very small and complex neonates should be managed with a staged approach. However, current data strongly suggest that neonates of at least average size as well as young infants have improved survival and reduced reintervention as well as markedly reduced time in hospital and overall costs when a strategy of early primary repair is pursued.

We report a case of 24-year-old man with single ventricle congenital heart disease and concomitant familial Fabry disease who developed progressive subaortic stenosis 22 years after Fontan procedure. Despite stable ventricular volumes, subaortic stenosis developed due to Fabry disease-related myocardial hypertrophy. He underwent pulmonary arterial trunk reconstruction with valved conduit and Damus-Kaye-Stansel (DKS) anastomosis. Postoperatively, smooth outflow tracts and stable valve function were observed. This case highlights the impact of Fabry disease on ventricular outflow tract obstruction and shows the efficacy of the DKS anastomosis in treating subaortic stenosis.

BackgroundValve-sparing repair for tetralogy of Fallot is challenging in patients with hypoplastic pulmonary valves. Recently, we adopted transannular incision and delamination. This study evaluates its feasibility for right ventricular outflow relief, valve function, and growth.MethodsWe retrospectively reviewed records of patients with tetralogy of Fallot or Fallot-type double-outlet right ventricle who underwent intracardiac repair from October 2013 to December 2020.ResultsTwenty-six patients were enrolled. Two patients who underwent the Rastelli procedure were excluded, leaving 24 for evaluation. Eleven underwent valve-sparing repair, eight underwent valve-preserving repair with transannular delamination, and five underwent the transannular patch procedure. The median age and weight at surgery were 11.7 months (1.9-40.2 months) and 7.6 kg (3.7-12.7 kg). No patients died or required reintervention for pulmonary valve stenosis or regurgitation during a median follow-up of 42.5 months (4.6-72.1 months). In the delamination group, the mean preoperative pulmonary valve z-score was -2.1 ± 1.0, improving significantly to 0.2 ± 0.8. Pulmonary regurgitation was mild in six of eight patients, while two with the smallest preoperative annulus developed moderate regurgitation. Despite no significant difference in the preoperative pulmonary valve annulus between the delamination and transannular patch groups, the delamination group had significantly lower postoperative pulmonary valve regurgitation, while no significant difference in stenosis.ConclusionsValve-preserving repair using the transannular delamination technique is feasible in patients with tetralogy of Fallot, reducing pulmonary regurgitation and avoiding transannular patch use. Long-term data with more patients are required to show the utility of this approach.

BackgroundLeft heart failure is the most common cause of pulmonary hypertension and increases morbidity and mortality. We investigate the use of canagliflozin, an antidiabetic Sodium-glucose Cotransporter-2 Inhibitor, which is first-line therapy in congestive heart failure, on pulmonary fibrosis in a porcine model of chronic myocardial ischemia.MethodologySixteen Yorkshire swine, eight in a normal diet control arm (NDC) and eight in the canagliflozin arm (CAN), underwent left thoracotomy and ameroid constrictor placement on the left circumflex artery. Seven weeks after placement, the swine underwent harvest procedure. During harvest, left ventricular contractility was quantified by direct left ventricular pressure-volume loops. Protein expression was quantified by immunoblotting and Masson's trichrome staining was utilized to assess perivascular collagen deposition.ResultsAnalysis of left ventricular ejection fraction demonstrated no significant difference between CAN and NDC. Western blot analysis demonstrated increases in TGFβ signaling pathways with decreased free TGFβ and TGFβ monomers in CAN pigs (p < 0.01). Downstream mediators of TGFβ were also increased in NDC with an increase in phospho-SMAD2/3 activity (p = 0.005). Masson's Trichrome analysis of lung tissue demonstrated a trend toward reduced perivascular collagen deposition in CAN swine lungs (p = 0.086).ConclusionsCanagliflozin ameliorates chronic fibrotic changes related to pulmonary hypertension in left ventricular failure. While there was a strong trend toward significance in histologic analysis, this may be limited by the duration of our model. Western blot analysis, however, demonstrates that CAN's modulation of TGFβ signaling pathways may play a role in the management of secondary pulmonary hypertension.

A 48-year-old woman, who had undergone surgery to treat a patent ductus arteriosus when she was 12 years old, was diagnosed with anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) and moderate mitral regurgitation during a routine exam. She underwent ALCAPA repair with an intrapulmonary tunnel using a vascular prosthesis and mitral valve repair. She experienced significant symptom improvement and has been free of heart failure symptoms after surgery. Anomalous origin of the left coronary artery from the pulmonary artery is rare but life-threatening, necessitating surgical intervention even in asymptomatic adults. Choosing an appropriate surgical approach is important, considering the patient's age and future intervention potential.