Mohamed Elbayomi, P Pathare, E Nooh, F Harig, F Abdullayev, M Weyand
Partial anomalous pulmonary venous drainage (PAPVD) is a relatively uncommon cardiac anomaly. The diagnosis might be challenging as are the presenting symptoms. Its clinical course mimics more familiar diseases, e.g., pulmonary artery embolism. We present a case of PAPVD, which had been misdiagnosed for more than two decades. After establishing the correct diagnosis, the patient got his congenital anomaly surgically corrected and showed excellent cardiac recovery in the six months follow up.
{"title":"Better Late Than Never - A Case of a Congenital Left Partial Anomalous Pulmonary Venous Drainage Diagnosed and Treated in The Sixth Decade of Life.","authors":"Mohamed Elbayomi, P Pathare, E Nooh, F Harig, F Abdullayev, M Weyand","doi":"10.1532/hsf.5273","DOIUrl":"https://doi.org/10.1532/hsf.5273","url":null,"abstract":"<p><p>Partial anomalous pulmonary venous drainage (PAPVD) is a relatively uncommon cardiac anomaly. The diagnosis might be challenging as are the presenting symptoms. Its clinical course mimics more familiar diseases, e.g., pulmonary artery embolism. We present a case of PAPVD, which had been misdiagnosed for more than two decades. After establishing the correct diagnosis, the patient got his congenital anomaly surgically corrected and showed excellent cardiac recovery in the six months follow up.</p>","PeriodicalId":51056,"journal":{"name":"Heart Surgery Forum","volume":"26 2","pages":"E170-E173"},"PeriodicalIF":0.6,"publicationDate":"2023-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9252247","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: The risk of coronary artery disease (CAD) in different valve dysfunction has been unclear.
Methods: We reviewed patients, who underwent valve heart surgery and coronary angiography from 2008 to 2021, at our center.
Results: A total of 7,932 patients were included in the present study, and 1,332 (16.8%) had CAD. The mean age of the study cohort was 60.5±7.9 years, and 4,206 (53.0%) were male. CAD was 21.4% in aortic disease, 16.2% in mitral valve disease, 11.8% in isolated tricuspid valve disease, and 13.0% in combined aortic and mitral valve disease. Patients with aortic stenosis were older than those with regurgitation (63.6±7.4 years vs. 59.5±8.2 years, P < 0.001), and the CAD risks also were higher (28.0% vs. 19.2%, P < 0.001). The age difference was minimal (60.6±8.2 years vs. 59.5±6.7 years, P = 0.002) between patients with mitral valve regurgitation and stenosis, but the risks of CAD were twice high in regurgitation (20.2% vs. 10.5%, P < 0.001). When the type of valve impairment was not considered, non-rheumatic etiology, advanced age, male sex, hypertension, and diabetes were independent predictors of CAD.
Conclusion: In patients undergoing valve surgery, the prevalence of CAD was influenced by conventional risk factors. Importantly, CAD also was associated with the type and etiology of valve diseases.
背景:不同瓣膜功能障碍的冠状动脉疾病(CAD)风险尚不清楚。方法:我们回顾了2008年至2021年在我们中心接受心脏瓣膜手术和冠状动脉造影的患者。结果:本研究共纳入7932例患者,其中1332例(16.8%)患有CAD。研究队列的平均年龄为60.5±7.9岁,男性4206例(53.0%)。主动脉疾病为21.4%,二尖瓣疾病为16.2%,孤立三尖瓣疾病为11.8%,主动脉和二尖瓣合并疾病为13.0%。主动脉瓣狭窄患者比反流患者年龄更大(63.6±7.4岁比59.5±8.2岁,P < 0.001),冠心病风险也更高(28.0%比19.2%,P < 0.001)。二尖瓣返流和狭窄患者的年龄差异很小(60.6±8.2岁vs 59.5±6.7岁,P = 0.002),但返流患者的冠心病风险是其两倍(20.2% vs 10.5%, P < 0.001)。当不考虑瓣膜损害类型时,非风湿病病因、高龄、男性、高血压和糖尿病是CAD的独立预测因素。结论:在瓣膜手术患者中,冠心病的患病率受常规危险因素的影响。重要的是,CAD还与瓣膜疾病的类型和病因有关。
{"title":"Prevalence of Coronary Artery Disease in Patients Undergoing Valvular Heart Surgery.","authors":"Changwei Ren, Jianbo Yu, Jinwei Zhang, Shengwei Wang, Enjun Zhu, Hongchang Guo, Dingce Sun, Bing Tang, Hao Cui, Yongqiang Lai","doi":"10.1532/hsf.5331","DOIUrl":"https://doi.org/10.1532/hsf.5331","url":null,"abstract":"<p><strong>Background: </strong>The risk of coronary artery disease (CAD) in different valve dysfunction has been unclear.</p><p><strong>Methods: </strong>We reviewed patients, who underwent valve heart surgery and coronary angiography from 2008 to 2021, at our center.</p><p><strong>Results: </strong>A total of 7,932 patients were included in the present study, and 1,332 (16.8%) had CAD. The mean age of the study cohort was 60.5±7.9 years, and 4,206 (53.0%) were male. CAD was 21.4% in aortic disease, 16.2% in mitral valve disease, 11.8% in isolated tricuspid valve disease, and 13.0% in combined aortic and mitral valve disease. Patients with aortic stenosis were older than those with regurgitation (63.6±7.4 years vs. 59.5±8.2 years, P < 0.001), and the CAD risks also were higher (28.0% vs. 19.2%, P < 0.001). The age difference was minimal (60.6±8.2 years vs. 59.5±6.7 years, P = 0.002) between patients with mitral valve regurgitation and stenosis, but the risks of CAD were twice high in regurgitation (20.2% vs. 10.5%, P < 0.001). When the type of valve impairment was not considered, non-rheumatic etiology, advanced age, male sex, hypertension, and diabetes were independent predictors of CAD.</p><p><strong>Conclusion: </strong>In patients undergoing valve surgery, the prevalence of CAD was influenced by conventional risk factors. Importantly, CAD also was associated with the type and etiology of valve diseases.</p>","PeriodicalId":51056,"journal":{"name":"Heart Surgery Forum","volume":"26 2","pages":"E141-E147"},"PeriodicalIF":0.6,"publicationDate":"2023-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9252242","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mohamed Elbayomi, Michael Weyand, Presheet Pathare, Ehab Nooh, Frank Harig
Background: The optimal management strategy for acute aortic type A dissection remains controversial. Whether a limited primary (index) repair would increase the need for late aortic reintervention is still an open debate.
Methods: A total of 393 consecutive adult patients with acute type A aortic dissection who underwent cardiac surgery were analyzed. Our research hypothesis was whether limited aortic index repair (i.e., isolated aorta ascending replacement without an open distal anastomosis with and without a concomitant aortic valve replacement, including hemiarch replacement procedure) is associated with a higher incidence of late aortic reoperation compared with extended repair (i.e., any other surgical procedure that goes beyond that limited approach).
Results: Type of the initial repair had no statically significant relationship with in-hospital mortality with a P-value of 0.12, however in multivariable analysis, cross-clamp time had a statistically significant relation with mortality (P = 0.4). From the patients who survived until discharge (N = 311), 40 patients needed a reoperation on the aorta; the mean interval until reoperation was 4.5 years. The relationship between the type of the initial repair and the need for reoperation didn't reach a statically significant value (P = 0.9). In-hospitable mortality after the second operation was 10% (N = 4).
Conclusion: We reached two conclusions. 1) An extended prophylactic repair in the initial operation of an acute type A aortic dissection might not lead to a lower incidence of reoperations on the aorta and could increase in-hospital mortality by increasing cross-clamp time, and 2) Reoperation on the aorta could be done safely with acceptable mortality outcomes.
{"title":"Single-Center Retrospective Analysis of Acute Type A Aortic Dissection Outcome and Reoperation Focusing on Extended Versus Limited Initial Repair.","authors":"Mohamed Elbayomi, Michael Weyand, Presheet Pathare, Ehab Nooh, Frank Harig","doi":"10.1532/hsf.5345","DOIUrl":"https://doi.org/10.1532/hsf.5345","url":null,"abstract":"<p><strong>Background: </strong>The optimal management strategy for acute aortic type A dissection remains controversial. Whether a limited primary (index) repair would increase the need for late aortic reintervention is still an open debate.</p><p><strong>Methods: </strong>A total of 393 consecutive adult patients with acute type A aortic dissection who underwent cardiac surgery were analyzed. Our research hypothesis was whether limited aortic index repair (i.e., isolated aorta ascending replacement without an open distal anastomosis with and without a concomitant aortic valve replacement, including hemiarch replacement procedure) is associated with a higher incidence of late aortic reoperation compared with extended repair (i.e., any other surgical procedure that goes beyond that limited approach).</p><p><strong>Results: </strong>Type of the initial repair had no statically significant relationship with in-hospital mortality with a P-value of 0.12, however in multivariable analysis, cross-clamp time had a statistically significant relation with mortality (P = 0.4). From the patients who survived until discharge (N = 311), 40 patients needed a reoperation on the aorta; the mean interval until reoperation was 4.5 years. The relationship between the type of the initial repair and the need for reoperation didn't reach a statically significant value (P = 0.9). In-hospitable mortality after the second operation was 10% (N = 4).</p><p><strong>Conclusion: </strong>We reached two conclusions. 1) An extended prophylactic repair in the initial operation of an acute type A aortic dissection might not lead to a lower incidence of reoperations on the aorta and could increase in-hospital mortality by increasing cross-clamp time, and 2) Reoperation on the aorta could be done safely with acceptable mortality outcomes.</p>","PeriodicalId":51056,"journal":{"name":"Heart Surgery Forum","volume":"26 2","pages":"E164-E169"},"PeriodicalIF":0.6,"publicationDate":"2023-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9252244","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Although the transplantation of tissue-engineered cardiac patches with adult bone marrow-derived mesenchymal stem cells (MSCs) can enhance cardiac function after acute or chronic myocardial infarction (MI), the recovery mechanism remains controversial. This experiment aimed to investigate the outcome measurements of MSCs within a tissue-engineered cardiac patch in a rabbit chronic MI model.
Methods: This experiment was divided into four groups: left anterior descending artery (LAD) sham-operation group (N = 7), sham-transplantation (control, N = 7), non-seeded patch group (N = 7), and MSCs-seeded patch group (N = 6). PKH26 and 5-Bromo-2'-deoxyuridine (BrdU) labeled MSCs-seeded or non-seeded patches were transplanted onto chronically infarct rabbit hearts. Cardiac function was evaluated by cardiac hemodynamics. H&E staining was performed to count the number of vessels in the infarcted area. Masson staining was used to observe cardiac fiber formation and to measure scar thickness.
Results: Four weeks after transplantation, a remarkable improvement in cardiac functionality could be distinctly observed, which was most significant in the MSCs-seeded patch group. Moreover, labeled cells were detected in the myocardial scar, with most of them differentiated into myofibroblasts, some into smooth muscle cells, and only a few into cardiomyocytes in the MSCs-seeded patch group. We also observed significant revascularization in the infarct area implanted in either MSCs-seeded or non-seeded patches. In addition, there were significantly greater numbers of microvessels in the MSCs-seeded patch group than in the non-seeded patch group.
{"title":"Adult Bone Marrow-Derived Mesenchymal Stem Cells Seeded on Tissue-Engineered Cardiac Patch Contribute to Myocardial Scar Remodeling and Enhance Revascularization in a Rabbit Model of Chronic Myocardial Infarction.","authors":"Jue Zhang, Mingjiang Wu, Xiaoqiang Zhang, Mingli Yang, Tingwang Xiong, Wei Zhi","doi":"10.1532/hsf.5067","DOIUrl":"https://doi.org/10.1532/hsf.5067","url":null,"abstract":"<p><strong>Background: </strong>Although the transplantation of tissue-engineered cardiac patches with adult bone marrow-derived mesenchymal stem cells (MSCs) can enhance cardiac function after acute or chronic myocardial infarction (MI), the recovery mechanism remains controversial. This experiment aimed to investigate the outcome measurements of MSCs within a tissue-engineered cardiac patch in a rabbit chronic MI model.</p><p><strong>Methods: </strong>This experiment was divided into four groups: left anterior descending artery (LAD) sham-operation group (N = 7), sham-transplantation (control, N = 7), non-seeded patch group (N = 7), and MSCs-seeded patch group (N = 6). PKH26 and 5-Bromo-2'-deoxyuridine (BrdU) labeled MSCs-seeded or non-seeded patches were transplanted onto chronically infarct rabbit hearts. Cardiac function was evaluated by cardiac hemodynamics. H&E staining was performed to count the number of vessels in the infarcted area. Masson staining was used to observe cardiac fiber formation and to measure scar thickness.</p><p><strong>Results: </strong>Four weeks after transplantation, a remarkable improvement in cardiac functionality could be distinctly observed, which was most significant in the MSCs-seeded patch group. Moreover, labeled cells were detected in the myocardial scar, with most of them differentiated into myofibroblasts, some into smooth muscle cells, and only a few into cardiomyocytes in the MSCs-seeded patch group. We also observed significant revascularization in the infarct area implanted in either MSCs-seeded or non-seeded patches. In addition, there were significantly greater numbers of microvessels in the MSCs-seeded patch group than in the non-seeded patch group.</p>","PeriodicalId":51056,"journal":{"name":"Heart Surgery Forum","volume":"26 2","pages":"E148-E155"},"PeriodicalIF":0.6,"publicationDate":"2023-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9199505","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Urška Intihar, Jernej Železnik, Tomaž Brajlih, Igor Drstvenšek, Radovan Hudak, Miha Antonič
Sternal dehiscence is an important complication that increases mortality and morbidity in cardiac surgery. Titanium plates have been used to reconstruct the chest wall for a long time. However, with the rise of 3D printing technology, a more sophisticated method, is making a breakthrough. Custom-made 3D-printed titanium prostheses are increasingly used in chest wall reconstruction because they allow almost perfect fitting to the patient's chest wall and lead to good functional and cosmetic results. This report presents a complex anterior chest wall reconstruction using a custom-made titanium 3D-printed implant in a patient with a sternal dehiscence after coronary artery bypass surgery. At first, reconstruction of the sternum was performed using conventional methods, which failed to give adequate results. Finally, a 3D-printed titanium custom-made prosthesis was used for the first time in our center. On the short- and mid-term follow up, good functional results were achieved. In conclusion, this method is suitable for sternal reconstruction after complications in the healing process of median sternotomy wounds in cardiac surgery, especially where other methods do not provide satisfactory results.
{"title":"Sternal Reconstruction Using 3D-Printed Titanium Custom-Made Prosthesis for Sternal Dehiscence After Cardiac Surgery.","authors":"Urška Intihar, Jernej Železnik, Tomaž Brajlih, Igor Drstvenšek, Radovan Hudak, Miha Antonič","doi":"10.1532/hsf.5151","DOIUrl":"https://doi.org/10.1532/hsf.5151","url":null,"abstract":"<p><p>Sternal dehiscence is an important complication that increases mortality and morbidity in cardiac surgery. Titanium plates have been used to reconstruct the chest wall for a long time. However, with the rise of 3D printing technology, a more sophisticated method, is making a breakthrough. Custom-made 3D-printed titanium prostheses are increasingly used in chest wall reconstruction because they allow almost perfect fitting to the patient's chest wall and lead to good functional and cosmetic results. This report presents a complex anterior chest wall reconstruction using a custom-made titanium 3D-printed implant in a patient with a sternal dehiscence after coronary artery bypass surgery. At first, reconstruction of the sternum was performed using conventional methods, which failed to give adequate results. Finally, a 3D-printed titanium custom-made prosthesis was used for the first time in our center. On the short- and mid-term follow up, good functional results were achieved. In conclusion, this method is suitable for sternal reconstruction after complications in the healing process of median sternotomy wounds in cardiac surgery, especially where other methods do not provide satisfactory results.</p>","PeriodicalId":51056,"journal":{"name":"Heart Surgery Forum","volume":"26 2","pages":"E160-E163"},"PeriodicalIF":0.6,"publicationDate":"2023-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9252246","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A 37-year-old male patient with corrected transposition of great arteries (ccTGA) with cor triatriatum sinister (CTS), left superior vena cava, and atrial septal defects is reported in our case. None of these impacted the patient's growth or development, nor daily work until age 33. Later, the patient developed symptoms of obvious impaired heart function, which improved after medical treatment. However, the symptoms reappeared and gradually worsened two years later, and we decided to treat it with surgery. In this case, we selected tricuspid mechanical valve replacement, cor triatriatum correction, and atrial septal defect repair. During the follow-up of five years, the patient had no obvious symptoms, ECG did not change significantly from five years ago, and the cardiac color Doppler ultrasound showed RVEF 0.51.
{"title":"Corrected Transposition of Great Arteries with Cor Triatriatum and Atrial Septal Defect-Case Report.","authors":"Lingwei Meng, Xiangjin Kong, Kaiming Wei, Xin Lv, Chuanzhen Liu, Weidong Bing","doi":"10.1532/hsf.5173","DOIUrl":"https://doi.org/10.1532/hsf.5173","url":null,"abstract":"<p><p>A 37-year-old male patient with corrected transposition of great arteries (ccTGA) with cor triatriatum sinister (CTS), left superior vena cava, and atrial septal defects is reported in our case. None of these impacted the patient's growth or development, nor daily work until age 33. Later, the patient developed symptoms of obvious impaired heart function, which improved after medical treatment. However, the symptoms reappeared and gradually worsened two years later, and we decided to treat it with surgery. In this case, we selected tricuspid mechanical valve replacement, cor triatriatum correction, and atrial septal defect repair. During the follow-up of five years, the patient had no obvious symptoms, ECG did not change significantly from five years ago, and the cardiac color Doppler ultrasound showed RVEF 0.51.</p>","PeriodicalId":51056,"journal":{"name":"Heart Surgery Forum","volume":"26 2","pages":"E156-E159"},"PeriodicalIF":0.6,"publicationDate":"2023-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9252248","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Shijie Zhang, Shanghao Chen, Kun Yang, Yi Li, Yan Yun, Xiangxi Zhang, Xing Qi, Xiaoming Zhou, Haizhou Zhang, Chengwei Zou, Xiaochun Ma
Background: The optimal revascularization strategy for isolated left anterior descending (LAD) coronary artery lesion between minimally invasive direct coronary artery bypass (MIDCAB) and percutaneous coronary intervention (PCI) remains controversial. This updated meta-analysis aims to compare the long- and short-term outcomes of MIDCAB versus PCI for patients with isolated LAD coronary artery lesions.
Methods: The Pubmed, Web of Science, and Cochrane databases were searched for retrieving potential publications from 2002 to 2022. The primary outcome was long-term survival. Secondary outcomes were long-term target vessel revascularization (TVR), long-term major adverse cardiovascular events (MACEs), and short-term outcomes, including postoperative mortality, myocardial infarction (MI), TVR, and MACEs of any cause in-hospital or 30 days after the revascularization.
Results: Six randomized controlled trials (RCTs) and eight observational studies were included in this updated meta-analysis. In total, 1757 patients underwent MIDCAB and 15245 patients underwent PCI. No statistically significant difference was found between the two groups in the rates of long-term survival. MIDCAB had a lower long-term MACE rate compared with PCI. Besides, PCI resulted in an augmented risk of TVR. Postoperative mortality, MI, TVR, and MACEs were similar between the two groups.
Conclusions: The updated meta-analysis presents the evidence that MIDCAB has a reduced risk of long-term TVR and MACEs, with no benefit in terms of long-term mortality and short-term results, in comparison with PCI. Large multicenter RCTs, including patients treated with newer techniques, are warranted in the future.
背景:在微创直接冠状动脉搭桥术(MIDCAB)和经皮冠状动脉介入治疗(PCI)之间,孤立的左前降支(LAD)冠状动脉病变的最佳血运重建策略仍存在争议。这项最新的荟萃分析旨在比较MIDCAB与PCI对孤立LAD冠状动脉病变患者的长期和短期结果。方法:检索Pubmed、Web of Science和Cochrane数据库,检索2002 - 2022年的潜在出版物。主要终点是长期生存。次要结局是长期靶血管重建术(TVR)、长期主要不良心血管事件(mace)和短期结局,包括术后死亡率、心肌梗死(MI)、TVR和院内或血运重建术后30天内任何原因的mace。结果:6项随机对照试验(rct)和8项观察性研究纳入了这一更新的荟萃分析。共有1757例患者接受了MIDCAB, 15245例患者接受了PCI。两组患者的长期生存率无统计学差异。与PCI相比,MIDCAB的长期MACE率较低。此外,PCI增加了TVR的风险。两组术后死亡率、心肌梗死、TVR和mace相似。结论:最新的荟萃分析显示,与PCI相比,MIDCAB具有降低长期TVR和mace风险的证据,但在长期死亡率和短期结果方面没有益处。大型多中心随机对照试验,包括采用新技术治疗的患者,将在未来得到保证。
{"title":"Minimally Invasive Direct Coronary Artery Bypass Versus Percutaneous Coronary Intervention for Isolated Left Anterior Descending Artery Stenosis: An Updated Meta-Analysis.","authors":"Shijie Zhang, Shanghao Chen, Kun Yang, Yi Li, Yan Yun, Xiangxi Zhang, Xing Qi, Xiaoming Zhou, Haizhou Zhang, Chengwei Zou, Xiaochun Ma","doi":"10.1532/hsf.5211","DOIUrl":"https://doi.org/10.1532/hsf.5211","url":null,"abstract":"<p><strong>Background: </strong>The optimal revascularization strategy for isolated left anterior descending (LAD) coronary artery lesion between minimally invasive direct coronary artery bypass (MIDCAB) and percutaneous coronary intervention (PCI) remains controversial. This updated meta-analysis aims to compare the long- and short-term outcomes of MIDCAB versus PCI for patients with isolated LAD coronary artery lesions.</p><p><strong>Methods: </strong>The Pubmed, Web of Science, and Cochrane databases were searched for retrieving potential publications from 2002 to 2022. The primary outcome was long-term survival. Secondary outcomes were long-term target vessel revascularization (TVR), long-term major adverse cardiovascular events (MACEs), and short-term outcomes, including postoperative mortality, myocardial infarction (MI), TVR, and MACEs of any cause in-hospital or 30 days after the revascularization.</p><p><strong>Results: </strong>Six randomized controlled trials (RCTs) and eight observational studies were included in this updated meta-analysis. In total, 1757 patients underwent MIDCAB and 15245 patients underwent PCI. No statistically significant difference was found between the two groups in the rates of long-term survival. MIDCAB had a lower long-term MACE rate compared with PCI. Besides, PCI resulted in an augmented risk of TVR. Postoperative mortality, MI, TVR, and MACEs were similar between the two groups.</p><p><strong>Conclusions: </strong>The updated meta-analysis presents the evidence that MIDCAB has a reduced risk of long-term TVR and MACEs, with no benefit in terms of long-term mortality and short-term results, in comparison with PCI. Large multicenter RCTs, including patients treated with newer techniques, are warranted in the future.</p>","PeriodicalId":51056,"journal":{"name":"Heart Surgery Forum","volume":"26 1","pages":"E114-E125"},"PeriodicalIF":0.6,"publicationDate":"2023-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9177969","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A 63-year-old woman with a five-month history of pulmonary epithelioid hemangioendothelioma (PEH) presented to the emergency department, due to worsening dyspnea and chest pain. The electrocardiography showed a pattern of ST-segment elevation in leads I, AVL, and poor R-wave progression consistent with anterolateral ischemia. Emergent coronary angiography revealed severe stenosis of the left main coronary artery. Then, contrast-enhanced computed tomography scan indicated the right pulmonary artery and left main coronary artery narrowing by compression of metastasized PEH. Finally, the patient died of deteriorated multi-organ failure.
{"title":"Compression of the Pulmonary Artery and Coronary Artery Caused by Pulmonary Epithelioid Hemangioendothelioma: A Case Report.","authors":"Haihong Zhang, Qin Luo, Nan Xie, Liqun Zou","doi":"10.1532/hsf.5191","DOIUrl":"https://doi.org/10.1532/hsf.5191","url":null,"abstract":"A 63-year-old woman with a five-month history of pulmonary epithelioid hemangioendothelioma (PEH) presented to the emergency department, due to worsening dyspnea and chest pain. The electrocardiography showed a pattern of ST-segment elevation in leads I, AVL, and poor R-wave progression consistent with anterolateral ischemia. Emergent coronary angiography revealed severe stenosis of the left main coronary artery. Then, contrast-enhanced computed tomography scan indicated the right pulmonary artery and left main coronary artery narrowing by compression of metastasized PEH. Finally, the patient died of deteriorated multi-organ failure.","PeriodicalId":51056,"journal":{"name":"Heart Surgery Forum","volume":"26 1","pages":"E131-E133"},"PeriodicalIF":0.6,"publicationDate":"2023-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10823758","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Intraoperative aortic dissection is an extremely serious complication that should be prevented whenever possible. When it does occur, it requires urgent clinical management.
Case presentation: We report the case of a 78-year-old man with Marfan syndrome who developed an intraoperative complicated type B aortic dissection with a distal anastomosis entry site during total arch replacement for a chronic dissection.
Conclusion: Performing immediate thoracic endovascular aortic repair, we were able to improve malperfusion to the lower extremities occurred during total arch replacement.
{"title":"Intraoperative Type B Aortic Dissection during Total Arch Replacement.","authors":"Yojiro Machii, Naohiro Shimada, Fumihiro Kitashima, Masashi Tanaka","doi":"10.1532/hsf.5179","DOIUrl":"https://doi.org/10.1532/hsf.5179","url":null,"abstract":"<p><strong>Background: </strong>Intraoperative aortic dissection is an extremely serious complication that should be prevented whenever possible. When it does occur, it requires urgent clinical management.</p><p><strong>Case presentation: </strong>We report the case of a 78-year-old man with Marfan syndrome who developed an intraoperative complicated type B aortic dissection with a distal anastomosis entry site during total arch replacement for a chronic dissection.</p><p><strong>Conclusion: </strong>Performing immediate thoracic endovascular aortic repair, we were able to improve malperfusion to the lower extremities occurred during total arch replacement.</p>","PeriodicalId":51056,"journal":{"name":"Heart Surgery Forum","volume":"26 1","pages":"E111-E113"},"PeriodicalIF":0.6,"publicationDate":"2023-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10811801","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Huan Xu, Yin-Ying Xue, Xiao Shen, Liang Hong, Cui Zhang
Objective: The emergence of critical values gives a warning to the medical safety of hospitalized patients, especially Cardiosurgery Intensive Care Unit (CSICU) patients. The aim of this study was to investigate the association between early postoperative critical values and the prognosis of patients after cardiac surgery.
Methods: Clinical data of the patients were obtained from the Cardiac Critical Care Clinical Database of the Cardiovascular Intensive Care Unit of Nanjing First Hospital. A total of 1,598 consecutive patients undergoing cardiac surgery were enrolled in this retrospective cohort study, during the period from July 2019 to December 2020. According to whether critical value occurred within 7 days after cardiac surgery, patients were divided into two groups: the critical value group and control group. COX regression and survival analysis were performed to analyze the clinical data of the two groups. The area under the receiver operating characteristic curve (ROC) was used to assess the critical value's predictive value and determine the optimal cutoff value.
Results: With patients in the critical value group, the 28-day mortality after cardiac surgery was 21.98%, significantly higher than that of the control group (P < 0.05). Logistic regression analysis revealed the APACHE II score (Adjusted HR-1.11, 95% CI-1.043-1.185) and critical value group (Adjusted HR-13.57, 95% CI-6.714-27.435 ) were independent predictors of 28-day mortality after cardiac surgery. The ROC curve showed that the critical value case model (AUC = 0.748 ± 0.052, P < 0.05) could effectively predict the 28-day mortality, and the optimum cutoff was 1 case (sensitivity 52.63%, specificity 95.70%).
Conclusions: One or more reported cases of critical values in the early postoperative period could be an independent risk factor for 28-day mortality in patients undergoing cardiac surgery. The predictive model based on critical value might be effective in clinical therapy and risk stratification.
{"title":"Association of Critical Value With 28-Day Mortality After Cardiac Surgery.","authors":"Huan Xu, Yin-Ying Xue, Xiao Shen, Liang Hong, Cui Zhang","doi":"10.1532/hsf.5215","DOIUrl":"https://doi.org/10.1532/hsf.5215","url":null,"abstract":"<p><strong>Objective: </strong>The emergence of critical values gives a warning to the medical safety of hospitalized patients, especially Cardiosurgery Intensive Care Unit (CSICU) patients. The aim of this study was to investigate the association between early postoperative critical values and the prognosis of patients after cardiac surgery.</p><p><strong>Methods: </strong>Clinical data of the patients were obtained from the Cardiac Critical Care Clinical Database of the Cardiovascular Intensive Care Unit of Nanjing First Hospital. A total of 1,598 consecutive patients undergoing cardiac surgery were enrolled in this retrospective cohort study, during the period from July 2019 to December 2020. According to whether critical value occurred within 7 days after cardiac surgery, patients were divided into two groups: the critical value group and control group. COX regression and survival analysis were performed to analyze the clinical data of the two groups. The area under the receiver operating characteristic curve (ROC) was used to assess the critical value's predictive value and determine the optimal cutoff value.</p><p><strong>Results: </strong>With patients in the critical value group, the 28-day mortality after cardiac surgery was 21.98%, significantly higher than that of the control group (P < 0.05). Logistic regression analysis revealed the APACHE II score (Adjusted HR-1.11, 95% CI-1.043-1.185) and critical value group (Adjusted HR-13.57, 95% CI-6.714-27.435 ) were independent predictors of 28-day mortality after cardiac surgery. The ROC curve showed that the critical value case model (AUC = 0.748 ± 0.052, P < 0.05) could effectively predict the 28-day mortality, and the optimum cutoff was 1 case (sensitivity 52.63%, specificity 95.70%).</p><p><strong>Conclusions: </strong>One or more reported cases of critical values in the early postoperative period could be an independent risk factor for 28-day mortality in patients undergoing cardiac surgery. The predictive model based on critical value might be effective in clinical therapy and risk stratification.</p>","PeriodicalId":51056,"journal":{"name":"Heart Surgery Forum","volume":"26 1","pages":"E126-E130"},"PeriodicalIF":0.6,"publicationDate":"2023-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10811803","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}