Cirugia Cardiovascular最新文献

Background

Tricuspid valve disease has been steadily increasing, raising concerns about the morbidity and mortality associated with surgery when performed via conventional sternotomy. In this context, the clinical and aesthetic advantages of isolated tricuspid surgery by right anterior mini-thoracotomy without aortic clamping are presented.

Material and methods

A case series of 29 patients who underwent minimally invasive isolated tricuspid valve surgery in our center, from 2014 to 2023, have been studied retrospectively. The operation was performed by right anterior mini-thoracotomy without caval exclusion and without aortic clamping to a beating heart assisted by 3 D videothoracoscopy. Preoperative levosimendan was administered in patients with severe pulmonary hypertension and/or right ventricular dysfunction.

Results

Twenty-eight tricuspid valve replacement and one repair were performed. Average patients age was 63 years old (SD 8 years old). 18 patients (62%) had previous cardiac surgery. 22 patients (75,8%) had severe pulmonary hypertension and 12 (41,3%) had right ventricule disfunction. Average EuroSCORE II was 4,10%. In-hospital mortality was 3,4% (one patient). The average extracorporeal circulation was 109 (SD 41 minutes). There was a reoperation due bleeding and a permanent pacemaker implantation (3,4%). Temporary renal replacement therapy was required in 21% (6 patients). The median length of hospital stay was 7 days.

Conclusions

Minimally invasive isolated tricuspid valve surgery is a safe technique as a definitive treatment of isolated tricuspid valve disease with a low mortality and morbidity.

Introduction

The use of biological valves in the aortic position has become more liberal in recent years due to improvements in prostheses and the possibility of performing valve-in-valve procedures, thus avoiding anticoagulation.

Methods

We retrospectively evaluated 246 adults in whom the Crown PRT^TM biological valve was used in the aortic position, including elective and emergency cases, isolated and combined surgeries (CS). We also evaluated mortality at 1, 3, and 5 years of follow-up.

Results

In this study, CS involved 94 patients (38%), while 39 patients (16%) underwent urgent or emergency procedures, which included cases of aortic dissection and endocarditis. Approximately 69% of the patients received a valve more significant than 21 mm. A minimally invasive surgical approach was employed in 42 patients (17%). The in-hospital mortality for the entire patient population was 3.6% (n = 9), with isolated aortic valve replacement (AVR) accounting for 3.3% (n = 5) and CS for another 4.3% (n = 4). The mortality for isolated AVR and CS in elective situations was n = 2 (1.3%) and n = 1 (1.1%), respectively. During the follow-up period, only seven patients required reoperation, with two patients (0.8%) experiencing structural valve deterioration and five other patients (2.1%) requiring reoperation due to prosthetic valve endocarditis.

Conclusion

The use of the Crown valve in the aortic position appears to be safe regarding postoperative morbidity and mortality. Further studies are necessary to assess its applicability in younger patients and predict its performance in the event of a valve-in-valve procedure.

Background

In skeletal muscle, adenosine triphosphate stores decrease during the first 3 h of ischemia. In the present study, we performed a comprehensive hemodynamic evaluation during the postoperative period after cardiac surgery and measured skeletal muscle enzyme levels and markers of muscle damage and inflammation. The aim was to determine whether these values change and, if so, whether these changes coincide with the presence of low flow and poor perfusion.

Methods

We included a cohort of 280 nonconsecutive adults who were monitored in the postoperative period following cardiac surgery. We measured hemodynamic indices repeatedly in the first 24 h postoperatively, and we identified differences between the levels of skeletal muscle enzymes and muscle damage markers on admission (0 h) and 12 and 24 h postoperatively.

Results

A clinically and statistically significant elevation of creatine kinase (CK) level was observed at 12 h postoperatively in patients with low macrocirculatory flow and anaerobic metabolism. Lactate dehydrogenase (LDH) level was significantly elevated in these patients at 24 h.

Conclusions

In the first 24 h after cardiac surgery, a state of low macrocirculatory flow and the consequent deficit in flow at the capillary–cell interface in the presence of anaerobic metabolism was associated with clinically and statistically significant elevations of CK level at 12 h and LDH level at 24 h. These changes may be markers of skeletal muscle ischemia and may provide an additional tool in the monitoring and resuscitation of these critically ill patients.

Background and aim

To determine differences in surgical procedures and clinical characteristics at the time of surgery between native tricuspid aortic valves (TAV) and bicuspid aortic valves (BAV).

Methods

429 adult patients who underwent aortic valve surgery ± ascendant aortic surgery ± coronary artery bypass grafting from September 2019 to September 2023 were retrospectively reviewed.

Results

Among the 429 patients, 298 (69.5%) had TAV and 131 had BAV (30.5%). BAV patients were significantly younger at the time of surgery than TAV patients (mean age 55.3 ± 10.6 years vs. 67.6 ± 9.2 years, P < .0001). BAV patients received more combined surgery of the aorta than TAV patients (33.6% vs 12.1%, P < .0001). In terms of surgical procedures, BAV patients received a significant higher percentage of isolated aortic valve repair and aortic root remodeling than TAV patients (13.0% and 6.1% versus 3.4% and 3.0%, respectively, P <. 0001). Global in-hospital mortality was 3.7% (BAV 0%, TAV 5.4%, P = .007). Overall 5-year mortality for TAV and BAV patients was 80.3% and 97.3%, respectively (P = .0003).

Conclusions

Compared with TAV patients, those with BAV represent a lower surgical risk profile subgroup of patients. Clinical and anatomical characteristics of BAV patients explain the higher percentages of surgical aortic valve/root repair techniques received and their better early and mid-term survival outcome.

The variations of the vessels that arise from the aortic arch are numerous, reported according to the literature consulted between 6 to 49% in various countries. Most variants are described as asymptomatic. However, some have been associated with significant symptoms and serious surgical problems, caused by the effects of compression or pressure that these variants exert on the trachea or esophagus. We present the case of a variant that we found no previous description in the literature, which was a trans surgical finding during a correction of a neonatal patient with a diagnosis of aortic coarctation.

We present the case of a 23-year-old man who was admitted to the emergency department due to thoracic trauma with a gunshot wound in the right fifth intercostal space with the anterior axillary line, with an outflow tract in the third intercostal space on the left parasternal line. The patient exhibited signs of cardiac tamponade and grade IV hemorrhagic shock. Bilateral tube thoracostomy was performed, yielding a substantial left hemothorax (1500 mL). As the patient presented deterioration of hemodynamic instability despite adequate resuscitation maneuvers, prompted immediate transportation to the operating room to perform a sternotomy. A posterior brachiocephalic trunk injury was identified, consisting of a laceration of 60% of total circumference, with an extension of over 2 cm. The distal portion of the injury was resected and reconstructed using a 6 mm polytetrafluoroethylene graft, with a proximal graft anastomosis employing a lateral anchor technique and a distal graft anastomosis using a parachute technique, secured with 4-0 polypropylene vascular sutures. The patient's postoperative recovery progressed favorably, he remained in the intensive care unit for 5 days and in general hospitalization for an additional 4 days. Further interventions were not required. A control CT angiography was performed 3 months postoperatively, demonstrating complete graft patency.

In recent years, there has been a notable shift in cardiovascular clinical practice within cardiology and surgery. The CARDIOXCARDIO study aimed to identify professionals’ opinions on working practices and relations between specialties. A survey was simultaneously sent to the 4442 members of the Spanish Society of Cardiovascular and Endovascular Surgery (SECCE) and the Spanish Society of Cardiology (SEC), yielding 385 valid responses. More than half (59%) of respondents were men, mostly specialists (7.3% residents), and 74.8% worked in the field of cardiology, predominantly in public centers (88.3%). Using a Likert scale ranging from 1 to 5 (worst to best), respondents rated relations between surgery and cardiology with an average of 3.57 ± 0.9 points. Cardiologists rated surgeons with a mean score of 3.83 ± 0.8, while surgeons gave cardiologists a mean score of 3,92 ± 0.72. In addition, respondents provided numerous suggestions for improvement, which are discussed in detail, highlighting certain discrepancies in criteria between specialties. Implementing strategies based on the suggestions of professionals, together with a proactive approach to continuous improvement, could substantially enhance the quality of cardiovascular care in Spain.