Heart Surgery Forum最新文献

Background: The independent predictive values of troponin I (cTnI) and B-type natriuretic peptide (BNP) after coronary artery bypass grafting (CABG) have been reported in several studies. However, adjustment only has been limited to preoperative risk factors.

Aim: This study was conducted to assess the independent values of postoperative cTnI and BNP to predict the outcome after CABG with adjustment for preoperative risk estimates and postoperative complications and to report risk stratification gains, when considering the European System for Cardiac Operative Risk Evaluation (EuroSCORE) combined with postoperative biomarkers.

Methods: This retrospective cohort study included 282 consecutive patients undergoing CABG between January 2018 and December 2021. We evaluated the preoperative and postoperative cTnI and BNP, EuroSCORE, and postoperative complications. The composite endpoint was death or cardiac-related adverse events.

Results: The AUROC for postoperative cTnI was significantly higher than that of BNP (0.777 vs. 0.625, p = 0.041). The optimal cut-off values to predict the composite outcome were >4830 (pg/mL) and >6.95 (ng/mL) for BNP and cTnI, respectively. Adjustment for relevant and significant perioperative factors showed that postoperative BNP and cTnI had a high discriminatory power (C-index = 0.773 and 0.895, respectively) for predicting major adverse events.

Conclusions: Postoperative BNP and cTnI are independent predictors of death or major adverse events, following CABG, and can add to the predictive power of EuroSCORE II.

Background: Delayed sternum closure is a crucial strategy in the management of hemodynamic instability after weaning from cardiopulmonary bypass. This study aimed to evaluate our outcomes with this technique in light of the literature.

Methods: We retrospectively reviewed the data of all the patients who developed postcardiotomy hemodynamic compromise and intraaotic balloon pump was inserted between November 2014 to January 2022. Patients were divided into two groups: primary sternal closure group, and delayed sternum closure group. Patients' demographic data, hemodynamic parameters, and postoperative morbidities were recorded.

Results: Delayed sternum closure was performed in 16 patients with an incidence of 3.6%. The most common indication was hemodynamic instability in 14 patients (82%), followed by arrhythmia in 2 patients (12%) and diffuse bleeding in 1 patient (6%). The mean time to sternum closure was 21 (±7) hours. Three patients died (19%), p > 0.999. The median follow-up period was 25 months. Survival analysis revealed that the survival rate was 92%, p = 0.921. Deep sternal infection was observed in one patient with (6%), p > 0.999. multivariate logistic regression analysis revealed that end-diastolic diameter [odds ratio (OR) 4.5, 95% CI (1.19-17), p = 0.027], right ventricle diameter [OR 3.9, 95% CI (1.3-10.7), p = 0.012] and aortic clamp time [OR 1.16, 95% CI (1.02-1.12), p = 0.008] were independent risk factors for delayed sternum closure.

Conclusions: Elective delayed sternal closure is a safe and effective method for treating postcardiotomy hemodynamic instability. It can be performed with a low incidence of mortality and sternal infections.

Background: In recent years, based on traditional median sternotomy surgery, totally thoracoscopic for aortic and mitral valve replacement surgery is increasingly being performed despite little published evidence. This study investigated postoperative pain and short-term quality of life (QOL) of patients undergoing double valve replacement surgery.

Methods: From November 2021 to December 2022, 141 patients with double valvular heart disease who underwent thoracoscopic group (N = 62) and median sternotomy group (N = 79) were included. Clinical data were recorded, and a visual analog scale (VAS) was used to measure postoperative pain intensity. The medical outcomes study (MOS) 36-item Short-Form Health Survey assessed short-term QOL after surgery.

Results: Sixty-two patients underwent total thoracic double valve replacement, and 79 patients underwent median sternotomy double valve replacement. Both groups were similar in terms of demographics and general clinical data, as well as the incidence of postoperative adverse events. The VAS scores of the thoracoscopic group were lower than those in the median sternotomy group. The hospital stay time was significantly shorter in the thoracoscopic group than in the median sternotomy group (30.2 ± 12 days vs. 36 ± 19 days, p = 0.03). The scores of bodily pains and some of the subscales in SF-36 were significantly different between the two groups (p < 0.05).

Conclusions: Thoracoscopic combined aortic and mitral valve replacement surgery can reduce postoperative pain and improve short-term postoperative QOL, which has specific clinical application value.

You, as third year medical students, are all among the best learners on the planet. You had to be to get into this, or any other, medical school. Your academic prowess has been put to good use both prior to and in the first couple of years of med school. However, you are getting ready to start into the rest of your careers, when many, if not most, of those finely tuned academic and personal skills will not be as applicable to learning and working as clinical trainees nor, eventually, medical practitioners, as those skills have been in most of your prior educational experiences. Candidly, when I was making this same transition myself, over four decades ago, it took me a while, probably quite a while, to really come to grips with this transition. Between those days and now, I have spent quite a lot of time immersed in medical education, at every level from younger medical students to chief residents training in thoracic and cardiovascular surgery. At each level of your education and training, you will have to sort out the best educational strategies for yourself.

Those who practice, and teach, thoracic and cardiovascular surgery and those who are training in this realm, as well as in many other disciplines, often endure debilitating physical stress and strain as a result of their practices. [Bishop, 2023] Despite the attention paid to issues such as proper adjustments for loupe magnification, optimal footwear, attention to 'micro-breaks', and paying attention to the ergonomics of performing long and intense operations, many surgeons still suffer discomfort and debility, and, even, disability. [Dalagher, 2019, Epstein, 2018, Alleblas, 2017, Giagio, 2019, Norasi, 2021] Dealing with those challenges should include what those practitioners can do outside of the operating room to increase their comfort and resilience, as well as what can be done in the operating room. One approach to dealing with these issues is to utilize the lessons and benefits of yoga. [Tribble, 2016].

Minimally invasive mitral valve surgery (MIMVS) is widespread and has become a standard procedure in cardiac surgery [Chitwood 1997; Carpentier 1996]. Therefore, MIMVS is a common procedure for patients with degenerative disease [Raanani 2010; Iribarne 2010] as well. However, the safety of MIMVS in patients with rheumatic heart disease (RHD) has not thoroughly been investigated, due to the low prevalence of RHD in developed countries, where MIMVS is standardized [Miceli 2015]. Here, we investigated the safety of MIMVS for patients with RHD at Lampang Hospital in Thailand.

We report a rare case of pelvic hematoma caused by iatrogenic external iliac artery hemorrhage following transfemoral venipuncture for atrial septal defect closure. By means of urgent femoral arteriography, bleeding in the branches of the external iliac artery was confirmed and occlusion of the bleeding branches was performed, thus avoiding the need for surgical laparotomy. The patient recovered well, and the hematoma significantly was reduced 2 months after surgery.

Background: A 78-year-old male was admitted to our institute with increasing shortness of breath and decreased exercise tolerance. His increasing symptoms were not relieved with medical management. He had a complex medical history that included aortic valve replacement (AVR). Echocardiography showed a deteriorating aortic bioprosthesis with severe aortic regurgitation.

Method: Intraoperative extraction of this prosthesis proved technically challenging and a valve in valve successfully was implanted as a salvage procedure.

Results: The procedure was successful, and the patient made a full recovery.

Conclusion: Open valve in valve implantation, despite technical difficulties, may be utilized as a salvage procedure.

Controlling the heart rate (HR) to a proper level is an important part during off-pump coronary artery bypass graft (CABG) surgery, particularly in two aspects. First, the oxygen consumption during cardiac work could be decreased, which is obviously beneficial for the myocardium suffering from inadequate blood supply. Second, slow heart action makes it easy for surgeons to perform. There are some treatments for lowering HR, where neostigmine is not commonly used but usually effective, which had been discussed more than 50 years ago. However, there are adverse responses that cannot be ignored and are even dangerous, for example, severe bradyarrhythmia and overload of secretion in the trachea. Here, we report a nodal tachycardia case after neostigmine infusion.

Background: Ascending aortic aneurysm accompanied with stanford type A aortic dissection is a life-threatening condition. The most common presenting symptom is pain. Here, we report a very rare case of giant asymptomatic ascending aortic aneurysm accompanied with chronic stanford type A aortic dissection.

Case presentation: A 72-year-old woman was founded to have ascending aortic dilation on a routine physical examination. On admission, CTA showed an ascending aortic aneurysm accompanied with stanford type A aortic dissection, the diameter of which was approximately 10 cm. Transthoracic echocardiography showed an ascending aortic aneurysm, aortic sinus and sinus junction dilation, moderate aortic valve regurgitation, left ventricle enlargement, left ventricular wall hypertrophy, and mitral and tricuspid valve mild regurgitation. The patient underwent surgical repair in our department, was discharged, and recovered well.

Conclusion: This was a very rare case of a giant asymptomatic ascending aortic aneurysm accompanied with chronic stanford type A aortic dissection that was successfully managed by total aortic arch replacement.