Pub Date : 2017-02-08DOI: 10.5761/atcs.oa.16-00219
Mingya Wang, Ming Chen, Hushan Ao, Sipeng Chen, Zhifa Wang
OBJECTIVE Blood loss is a predictor of outcomes after coronary artery bypass grafting (CABG). This study investigated the effects of body mass index (BMI) on blood loss, blood transfusion rate, and the variations in coagulation parameters of Chinese patients undergoing CABG. METHODS A total of 1007 Chinese patients who consecutively underwent isolated, primary CABG at Fuwai Hospital from January 1, 2013 to December 31, 2013 were included in this study. They were categorized by BMI into <24 kg/m2 (low and normal weight group), 24≤ BMI <28 kg/m2 (overweight group), and BMI ≥28 kg/m2 (obese group). Following this BMI classification, the quantities of blood lost and recorded transfusions were analyzed. RESULTS Blood loss and transfusion rates were significantly higher in the low and normal weight group compared with the obese group (p <0.01). Chest tube drainage over 24 h, duration of intensive care unit (ICU) stay, and postoperative mechanical ventilation were higher as well (p <0.01). Atrial fibrillation was closely related to blood transfusion (p <0.001). CONCLUSIONS Obesity is a predictor for protection against blood loss and transfusion in Chinese people. Patients with low and normal BMI lost more blood per kg of their weight and had higher total transfused volume during isolated primary CABG. Atrial fibrillation was associated with high blood transfusion.
{"title":"The Effects of Different BMI on Blood Loss and Transfusions in Chinese Patients Undergoing Coronary Artery Bypass Grafting.","authors":"Mingya Wang, Ming Chen, Hushan Ao, Sipeng Chen, Zhifa Wang","doi":"10.5761/atcs.oa.16-00219","DOIUrl":"https://doi.org/10.5761/atcs.oa.16-00219","url":null,"abstract":"OBJECTIVE\u0000Blood loss is a predictor of outcomes after coronary artery bypass grafting (CABG). This study investigated the effects of body mass index (BMI) on blood loss, blood transfusion rate, and the variations in coagulation parameters of Chinese patients undergoing CABG.\u0000\u0000\u0000METHODS\u0000A total of 1007 Chinese patients who consecutively underwent isolated, primary CABG at Fuwai Hospital from January 1, 2013 to December 31, 2013 were included in this study. They were categorized by BMI into <24 kg/m2 (low and normal weight group), 24≤ BMI <28 kg/m2 (overweight group), and BMI ≥28 kg/m2 (obese group). Following this BMI classification, the quantities of blood lost and recorded transfusions were analyzed.\u0000\u0000\u0000RESULTS\u0000Blood loss and transfusion rates were significantly higher in the low and normal weight group compared with the obese group (p <0.01). Chest tube drainage over 24 h, duration of intensive care unit (ICU) stay, and postoperative mechanical ventilation were higher as well (p <0.01). Atrial fibrillation was closely related to blood transfusion (p <0.001).\u0000\u0000\u0000CONCLUSIONS\u0000Obesity is a predictor for protection against blood loss and transfusion in Chinese people. Patients with low and normal BMI lost more blood per kg of their weight and had higher total transfused volume during isolated primary CABG. Atrial fibrillation was associated with high blood transfusion.","PeriodicalId":93877,"journal":{"name":"Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84962173","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}
Pub Date : 2017-02-03DOI: 10.5761/atcs.oa.16-00196
A. A. Juhl, Sofie Hody, T. S. Videbaek, T. Damsgaard, P. Nielsen
PURPOSE The present study aimed to compare the clinical outcome for patients with or without muscle flap reconstruction after deep sternal wound infection due to open-heart surgery. METHODS The study was a retrospective cohort study, including patients who developed deep sternal wound infection after open-heart surgery in the Western Denmark Region from 1999 to 2011. Journals of included patients were reviewed for clinical data regarding the treatment of their sternal defect. Patients were divided into two groups depending on whether they received a muscle-flap-based sternal reconstruction or traditional rewiring of the sternum. RESULTS A total of 130 patients developed deep sternal wound infection in the study period. In all, 12 patients died before being discharged, leaving a total of 118 patients for analysis. Of these, 50 (42%) patients received muscle flap reconstruction. Muscle flap recipients had significantly longer total hospital stays (p <0.001). However, after receiving muscle flap reconstruction, patients were discharged after a median of 14 days, with 74% not needing additional surgery. CONCLUSION It is difficult to predict which patients eventually require muscle flap reconstruction after deep sternal wound infection. Although patients receiving muscle flap reconstructions have longer hospital stays, they are quickly discharged after the reconstruction.
{"title":"Deep Sternal Wound Infection after Open-Heart Surgery: A 13-Year Single Institution Analysis.","authors":"A. A. Juhl, Sofie Hody, T. S. Videbaek, T. Damsgaard, P. Nielsen","doi":"10.5761/atcs.oa.16-00196","DOIUrl":"https://doi.org/10.5761/atcs.oa.16-00196","url":null,"abstract":"PURPOSE\u0000The present study aimed to compare the clinical outcome for patients with or without muscle flap reconstruction after deep sternal wound infection due to open-heart surgery.\u0000\u0000\u0000METHODS\u0000The study was a retrospective cohort study, including patients who developed deep sternal wound infection after open-heart surgery in the Western Denmark Region from 1999 to 2011. Journals of included patients were reviewed for clinical data regarding the treatment of their sternal defect. Patients were divided into two groups depending on whether they received a muscle-flap-based sternal reconstruction or traditional rewiring of the sternum.\u0000\u0000\u0000RESULTS\u0000A total of 130 patients developed deep sternal wound infection in the study period. In all, 12 patients died before being discharged, leaving a total of 118 patients for analysis. Of these, 50 (42%) patients received muscle flap reconstruction. Muscle flap recipients had significantly longer total hospital stays (p <0.001). However, after receiving muscle flap reconstruction, patients were discharged after a median of 14 days, with 74% not needing additional surgery.\u0000\u0000\u0000CONCLUSION\u0000It is difficult to predict which patients eventually require muscle flap reconstruction after deep sternal wound infection. Although patients receiving muscle flap reconstructions have longer hospital stays, they are quickly discharged after the reconstruction.","PeriodicalId":93877,"journal":{"name":"Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86241778","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}
Pub Date : 2017-01-24DOI: 10.5761/atcs.nm.16-00248
M. Yamazaki, H. Kin, Shohei Kitamoto, Shota Yamanaka, H. Nishida, K. Nishigawa, S. Takanashi
Minimally invasive cardiac surgeries for aortic valve replacement (AVR) are still a technical challenge for surgeons because these procedures are undertaken through small incisions and deep surgical fields. Although AVR via vertical infraaxillary thoracotomy can be a cosmetically superior option, a disadvantage of this approach is the distance between the thoracotomy incision and the ascending aorta. Therefore, we devised a technique to perform all manipulations using the fingertips without the aid of a knot pusher or long-shafted surgical instruments. This was achieved by particular placement of several retracted sutures to the right chest wall. We named placement of these sutures the "Stonehenge technique." In conclusion, AVR via vertical infraaxillary thoracotomy with our Stonehenge technique can be safely and simply performed with superior cosmetic advantages.
{"title":"Efficacy of the Stonehenge Technique for Minimally Invasive Aortic Valve Replacement via Right Infraaxillary Thoracotomy.","authors":"M. Yamazaki, H. Kin, Shohei Kitamoto, Shota Yamanaka, H. Nishida, K. Nishigawa, S. Takanashi","doi":"10.5761/atcs.nm.16-00248","DOIUrl":"https://doi.org/10.5761/atcs.nm.16-00248","url":null,"abstract":"Minimally invasive cardiac surgeries for aortic valve replacement (AVR) are still a technical challenge for surgeons because these procedures are undertaken through small incisions and deep surgical fields. Although AVR via vertical infraaxillary thoracotomy can be a cosmetically superior option, a disadvantage of this approach is the distance between the thoracotomy incision and the ascending aorta. Therefore, we devised a technique to perform all manipulations using the fingertips without the aid of a knot pusher or long-shafted surgical instruments. This was achieved by particular placement of several retracted sutures to the right chest wall. We named placement of these sutures the \"Stonehenge technique.\" In conclusion, AVR via vertical infraaxillary thoracotomy with our Stonehenge technique can be safely and simply performed with superior cosmetic advantages.","PeriodicalId":93877,"journal":{"name":"Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78360665","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}
Pub Date : 2017-01-01DOI: 10.5761/atcs.cr.16-00137
N. Haratake, F. Shoji, Yuka Kozuma, T. Okamoto, Y. Maehara
This report presents a rare case involving a patient with a giant leiomyoma originating from the mediastinal pleura. The patient underwent a medical examination, and chest radiography revealed a giant tumor. Computed tomography (CT) and magnetic resonance imaging (MRI) showed a well demarcated, heterogeneous mass which seemed to originate from the posterior mediastinum. Positron emission tomography (PET) showed the uptake of this tumor with a standardized uptake value of 4.9. We suspected that this tumor was a solitary fibrous tumor, and the patient underwent a surgical resection. Intraoperative exploration revealed a well-encapsulated tumor measuring 15 × 11 cm that appeared to originate from the mediastinal pleura. Immunohistochemical findings revealed a benign leiomyoma. We finally diagnosed the patient with a mediastinal leiomyoma. The present report describes CT, MRI, and PET findings of leiomyoma, and presents a review of relevant literature.
{"title":"Giant Leiomyoma Arising from the Mediastinal Pleura: A Case Report.","authors":"N. Haratake, F. Shoji, Yuka Kozuma, T. Okamoto, Y. Maehara","doi":"10.5761/atcs.cr.16-00137","DOIUrl":"https://doi.org/10.5761/atcs.cr.16-00137","url":null,"abstract":"This report presents a rare case involving a patient with a giant leiomyoma originating from the mediastinal pleura. The patient underwent a medical examination, and chest radiography revealed a giant tumor. Computed tomography (CT) and magnetic resonance imaging (MRI) showed a well demarcated, heterogeneous mass which seemed to originate from the posterior mediastinum. Positron emission tomography (PET) showed the uptake of this tumor with a standardized uptake value of 4.9. We suspected that this tumor was a solitary fibrous tumor, and the patient underwent a surgical resection. Intraoperative exploration revealed a well-encapsulated tumor measuring 15 × 11 cm that appeared to originate from the mediastinal pleura. Immunohistochemical findings revealed a benign leiomyoma. We finally diagnosed the patient with a mediastinal leiomyoma. The present report describes CT, MRI, and PET findings of leiomyoma, and presents a review of relevant literature.","PeriodicalId":93877,"journal":{"name":"Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89868784","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}
Pub Date : 2016-11-23DOI: 10.5761/atcs.oa.16-00179
F. Shoji, S. Takamori, T. Akamine, G. Toyokawa, Y. Morodomi, T. Okamoto, Y. Maehara
BACKGROUND Analog chest drainage systems (ACS) are generally used to monitor postoperative alveolar air leakage (PAL) after lung resection. An electronic digital chest drainage system (DCS) has recently been developed that reportedly has several advantages over the traditional ACS. Here, we report a single institution's experience of PAL management with the DCS. We also sought to establish whether DCS had superior clinical benefits and outcomes compared with ACS. METHODS We enrolled 112 consecutive patients who underwent lung resection and were subsequently managed with DCS. We compared PAL rate, duration of chest drainage, and the incidence of complications with a group of 121 consecutive patients previously managed with ACS after lung resection, using propensity score matching. RESULTS Mean maximum and minimum PAL rates during DCS chest drainage were 48.9 ml/min (range: 2.0-868.6 ml/min) and 0.1 ml/min (0.0-1.2 ml/min), respectively. Mean PAL rate at DCS removal was 1.3 ml/min (0.0-10.0 ml/min). After propensity score matching, mean duration of chest drainage was significantly shorter with DCS than ACS (2.7 days, range: 1-9 days, compared with 3.7 days, range: 1-21 days, respectively; P = 0.031). CONCLUSIONS Managing PAL with DCS after pulmonary resection appears to reduce the duration of chest drainage.
{"title":"Clinical Evaluation and Outcomes of Digital Chest Drainage after Lung Resection.","authors":"F. Shoji, S. Takamori, T. Akamine, G. Toyokawa, Y. Morodomi, T. Okamoto, Y. Maehara","doi":"10.5761/atcs.oa.16-00179","DOIUrl":"https://doi.org/10.5761/atcs.oa.16-00179","url":null,"abstract":"BACKGROUND\u0000Analog chest drainage systems (ACS) are generally used to monitor postoperative alveolar air leakage (PAL) after lung resection. An electronic digital chest drainage system (DCS) has recently been developed that reportedly has several advantages over the traditional ACS. Here, we report a single institution's experience of PAL management with the DCS. We also sought to establish whether DCS had superior clinical benefits and outcomes compared with ACS.\u0000\u0000\u0000METHODS\u0000We enrolled 112 consecutive patients who underwent lung resection and were subsequently managed with DCS. We compared PAL rate, duration of chest drainage, and the incidence of complications with a group of 121 consecutive patients previously managed with ACS after lung resection, using propensity score matching.\u0000\u0000\u0000RESULTS\u0000Mean maximum and minimum PAL rates during DCS chest drainage were 48.9 ml/min (range: 2.0-868.6 ml/min) and 0.1 ml/min (0.0-1.2 ml/min), respectively. Mean PAL rate at DCS removal was 1.3 ml/min (0.0-10.0 ml/min). After propensity score matching, mean duration of chest drainage was significantly shorter with DCS than ACS (2.7 days, range: 1-9 days, compared with 3.7 days, range: 1-21 days, respectively; P = 0.031).\u0000\u0000\u0000CONCLUSIONS\u0000Managing PAL with DCS after pulmonary resection appears to reduce the duration of chest drainage.","PeriodicalId":93877,"journal":{"name":"Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78077819","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}
Pub Date : 2016-11-14DOI: 10.5761/atcs.oa.16-00189
S. Lee, Do Hyung Kim, Sang Kwon Lee, Y. Kim, J. Cho, H. I
PURPOSE The choice of surgical repair or conservative treatment for iatrogenic tracheobronchial rupture (ITBR) remains controversial. However, thoracic surgeons consider that surgical repair is an important treatment modality. The purpose of this study was to evaluate the clinical results from the perspective of the surgery-preferred group. METHODS We treated 11 patients (8 women and 3 men; age: 52.6 ± 22.9 years) with ITBR from January 2011 to January 2016. A posterolateral thoracotomy or a trans-tracheal approach was performed according to the mechanism of injury. RESULTS Nine patients underwent surgery, and all patients received primary repair. Five patients received a right posterolateral thoracotomy, whereas one patient received a left posterolateral thoracotomy. No mortality or morbidity related to the surgery was observed. The mechanical ventilation time was 65.9 ± 99.2 hours. The intensive care unit duration was 19.7 ± 33.3 days. Two patients received conservative treatment, and all patients died of another disease that was not related to the conservative treatment. CONCLUSION Our mortality or morbidity due to surgery was not higher than world literature results of conservative treatment. We thought surgery is the primary treatment choice for ITBR in the absence of a good indication for conservative treatment.
{"title":"Does Surgical Repair Still have a Role for Iatrogenic Tracheobronchial Rupture? Clinical Analysis of a Thoracic Surgeon's Opinion.","authors":"S. Lee, Do Hyung Kim, Sang Kwon Lee, Y. Kim, J. Cho, H. I","doi":"10.5761/atcs.oa.16-00189","DOIUrl":"https://doi.org/10.5761/atcs.oa.16-00189","url":null,"abstract":"PURPOSE\u0000The choice of surgical repair or conservative treatment for iatrogenic tracheobronchial rupture (ITBR) remains controversial. However, thoracic surgeons consider that surgical repair is an important treatment modality. The purpose of this study was to evaluate the clinical results from the perspective of the surgery-preferred group.\u0000\u0000\u0000METHODS\u0000We treated 11 patients (8 women and 3 men; age: 52.6 ± 22.9 years) with ITBR from January 2011 to January 2016. A posterolateral thoracotomy or a trans-tracheal approach was performed according to the mechanism of injury.\u0000\u0000\u0000RESULTS\u0000Nine patients underwent surgery, and all patients received primary repair. Five patients received a right posterolateral thoracotomy, whereas one patient received a left posterolateral thoracotomy. No mortality or morbidity related to the surgery was observed. The mechanical ventilation time was 65.9 ± 99.2 hours. The intensive care unit duration was 19.7 ± 33.3 days. Two patients received conservative treatment, and all patients died of another disease that was not related to the conservative treatment.\u0000\u0000\u0000CONCLUSION\u0000Our mortality or morbidity due to surgery was not higher than world literature results of conservative treatment. We thought surgery is the primary treatment choice for ITBR in the absence of a good indication for conservative treatment.","PeriodicalId":93877,"journal":{"name":"Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83032300","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}
Pub Date : 2016-10-20DOI: 10.5761/ATCS.CR.15-00269
Hideaki Maeda, Tomofumi Umeda, Hideomi Kawachi, A. Iida, Yusuke Ishii, Michinari Kono, M. Shiono
PURPOSE Cystic adventitial artery disease is an uncommon non-atherosclerotic peripheral vessel disease. Furthermore cystic adventitial disease of the common femoral artery is an extremely rare entity. We report the case of a 54 year-old man complaining of intermittent claudication who was referred to our vascular service. METHODS AND RESULTS Doppler ultrasound and multidetector-row computed tomography (CT) with 3-dimensional volume rendering revealed severe stenosis with cystic an adventitial cyst in the common femoral artery. Intra-operative Doppler ultrasound showed the cyst to be multilocular type. Reversed great saphenous vein interposition was successfully placed. CONCLUSION Removal of cyst together with artery and interposition using reversed great saphenous vein is the optimal treatment procedure to prevent recurrence.
{"title":"Cystic Adventitial Disease of the Common Femoral Artery. Case Report and Review of the Literature.","authors":"Hideaki Maeda, Tomofumi Umeda, Hideomi Kawachi, A. Iida, Yusuke Ishii, Michinari Kono, M. Shiono","doi":"10.5761/ATCS.CR.15-00269","DOIUrl":"https://doi.org/10.5761/ATCS.CR.15-00269","url":null,"abstract":"PURPOSE\u0000Cystic adventitial artery disease is an uncommon non-atherosclerotic peripheral vessel disease. Furthermore cystic adventitial disease of the common femoral artery is an extremely rare entity. We report the case of a 54 year-old man complaining of intermittent claudication who was referred to our vascular service.\u0000\u0000\u0000METHODS AND RESULTS\u0000Doppler ultrasound and multidetector-row computed tomography (CT) with 3-dimensional volume rendering revealed severe stenosis with cystic an adventitial cyst in the common femoral artery. Intra-operative Doppler ultrasound showed the cyst to be multilocular type. Reversed great saphenous vein interposition was successfully placed.\u0000\u0000\u0000CONCLUSION\u0000Removal of cyst together with artery and interposition using reversed great saphenous vein is the optimal treatment procedure to prevent recurrence.","PeriodicalId":93877,"journal":{"name":"Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85207928","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}
Pub Date : 2016-10-11DOI: 10.5761/atcs.oa.16-00170
Bui Quoc Thang, T. Furugaki, M. Osaka, Yutaka Watanabe, S. Kanemoto, F. Suetsugu, Y. Hiramatsu
PURPOSE There is less certainty regarding the best strategy for treating neonates with functional single ventricle (SV) and hypoplastic aortic arch. We have applied a modified extended aortic arch anastomosis (EAAA) and main pulmonary artery banding (PAB) as an initial palliation in neonates with transverse arch hypoplasia and assessed the mid-term outcomes. METHODS In total, 10 neonates with functional SV and extensive hypoplasia or interruption of the arch underwent a modified EAAA (extended arch anastomosis with a subclavian flap) concomitant with main PAB through a thoracotomy without cardiopulmonary bypass. Patient age and weight ranged from 4 to 14 days and 2.3 to 3.8 kg, respectively. RESULTS There were no hospital deaths although there were two late deaths. Gradients across the arch were 0 to 7 mmHg at postoperative day 1 and no arch reoperations were required. Two patients required balloon aortoplasty. Nine underwent bidirectional cavopulmonary shunt and two of them needed concomitant Damus-Kaye-Stansel (DKS) anastomosis. Six have completed Fontan. CONCLUSION Our modification of EAAA with main PAB for SV neonates may benefit a certain population with transverse arch hypoplasia as an option to be considered. Patients with the potential for developing outflow obstruction may be best managed with an initial DKS-type palliation.
{"title":"Mid-Term Outcomes of a Modification of Extended Aortic Arch Anastomosis with Pulmonary Artery Banding in Single Ventricle Neonates with Hypoplastic Transverse Arch.","authors":"Bui Quoc Thang, T. Furugaki, M. Osaka, Yutaka Watanabe, S. Kanemoto, F. Suetsugu, Y. Hiramatsu","doi":"10.5761/atcs.oa.16-00170","DOIUrl":"https://doi.org/10.5761/atcs.oa.16-00170","url":null,"abstract":"PURPOSE\u0000There is less certainty regarding the best strategy for treating neonates with functional single ventricle (SV) and hypoplastic aortic arch. We have applied a modified extended aortic arch anastomosis (EAAA) and main pulmonary artery banding (PAB) as an initial palliation in neonates with transverse arch hypoplasia and assessed the mid-term outcomes.\u0000\u0000\u0000METHODS\u0000In total, 10 neonates with functional SV and extensive hypoplasia or interruption of the arch underwent a modified EAAA (extended arch anastomosis with a subclavian flap) concomitant with main PAB through a thoracotomy without cardiopulmonary bypass. Patient age and weight ranged from 4 to 14 days and 2.3 to 3.8 kg, respectively.\u0000\u0000\u0000RESULTS\u0000There were no hospital deaths although there were two late deaths. Gradients across the arch were 0 to 7 mmHg at postoperative day 1 and no arch reoperations were required. Two patients required balloon aortoplasty. Nine underwent bidirectional cavopulmonary shunt and two of them needed concomitant Damus-Kaye-Stansel (DKS) anastomosis. Six have completed Fontan.\u0000\u0000\u0000CONCLUSION\u0000Our modification of EAAA with main PAB for SV neonates may benefit a certain population with transverse arch hypoplasia as an option to be considered. Patients with the potential for developing outflow obstruction may be best managed with an initial DKS-type palliation.","PeriodicalId":93877,"journal":{"name":"Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84153029","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}
Pub Date : 2016-09-20DOI: 10.5761/ATCS.OA.16-00165
F. Nicolini, D. Fortuna, G. A. Contini, D. Pacini, D. Gabbieri, R. De Palma, T. Gherli
PURPOSE The introduction of transcatheter aortic valves has focused attention on the results of conventional aortic valve surgery in high-risk patients. The aim of the study was to evaluate 5-years outcomes in this category of patients in the current surgical era. METHODS This is an observational retrospective study of 581 high-risk patients undergoing aortic valve replacement from 2008 to 2013, with a mean logistic EuroSCORE of 26.6% ± 14.6%. Data were prospectively collected in a database of Emilia-Romagna region (Italy). RESULTS Overall 30-day mortality was 9.3%. Stroke rate was 1.5%. At 1-, 3-, and 5-years overall mortality was 18.2%, 30.4%, and 42.2%, cardiac death rate was 3.9%, 9.2%, and 12.9%, stroke rate 2.5%, 7.7%, and 10.2%, re-operation occurrence 0.2%, 0.9% and 1.3%, and new pacemaker implantation was 2.3%, 5.1% and 7.8%. At multivariate analysis, urgency, hemodynamic instability, LVEF ≤30%, NYHA III-IV, severe chronic obstructive pulmonary disease (COPD), extra-cardiac arteriopathy, cerebrovascular disease, and creatinine >2.0 mg/dL remained independent predictors of 5-year mortality. CONCLUSION The results of the current study add weight to the evidence that traditional aortic valve replacement can be performed in high-risk patients with satisfactory 5-year mortality and morbidity. Our study may help to improve decision-making in this category of high-risk patients with aortic valve disease.
{"title":"Long-Term Outcomes of Conventional Aortic Valve Replacement in High-Risk Patients: Where Do We Stand?","authors":"F. Nicolini, D. Fortuna, G. A. Contini, D. Pacini, D. Gabbieri, R. De Palma, T. Gherli","doi":"10.5761/ATCS.OA.16-00165","DOIUrl":"https://doi.org/10.5761/ATCS.OA.16-00165","url":null,"abstract":"PURPOSE\u0000The introduction of transcatheter aortic valves has focused attention on the results of conventional aortic valve surgery in high-risk patients. The aim of the study was to evaluate 5-years outcomes in this category of patients in the current surgical era.\u0000\u0000\u0000METHODS\u0000This is an observational retrospective study of 581 high-risk patients undergoing aortic valve replacement from 2008 to 2013, with a mean logistic EuroSCORE of 26.6% ± 14.6%. Data were prospectively collected in a database of Emilia-Romagna region (Italy).\u0000\u0000\u0000RESULTS\u0000Overall 30-day mortality was 9.3%. Stroke rate was 1.5%. At 1-, 3-, and 5-years overall mortality was 18.2%, 30.4%, and 42.2%, cardiac death rate was 3.9%, 9.2%, and 12.9%, stroke rate 2.5%, 7.7%, and 10.2%, re-operation occurrence 0.2%, 0.9% and 1.3%, and new pacemaker implantation was 2.3%, 5.1% and 7.8%. At multivariate analysis, urgency, hemodynamic instability, LVEF ≤30%, NYHA III-IV, severe chronic obstructive pulmonary disease (COPD), extra-cardiac arteriopathy, cerebrovascular disease, and creatinine >2.0 mg/dL remained independent predictors of 5-year mortality.\u0000\u0000\u0000CONCLUSION\u0000The results of the current study add weight to the evidence that traditional aortic valve replacement can be performed in high-risk patients with satisfactory 5-year mortality and morbidity. Our study may help to improve decision-making in this category of high-risk patients with aortic valve disease.","PeriodicalId":93877,"journal":{"name":"Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82303718","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}
Pub Date : 2016-09-13DOI: 10.5761/atcs.oa.16-00012
H. Kim, J. Y. Yoon, Kook Nam Han, Y. Choi
PURPOSE This study assessed physical development of patients with pectus excavatum and evaluated the effect of the Nuss procedure on physical development. METHODS A total of 146 patients underwent the Nuss procedure; of these, at the time of the study, the bar had been removed from 123 patients (84.9%; male 93, female 30) who were eligible for participation in this study. Heights and body weights of patients were measured prior to surgery and immediately before bar removal. Chest computed tomography (CT) was performed preoperatively and immediately before bar removal. The associations between physical development and chest CT indices were evaluated. RESULTS The height standard deviation score (SDS) was - 0.66 ± 2.23 preoperatively and 0.04 ± 1.34 immediately before bar removal (p <0.01). The weight SDS was - 0.02 ± 2.59 preoperatively; it increased significantly to 0.56 ± 1.56 immediately before bar removal (p <0.01). The Haller index (3.85 ± 1.18 to 2.99 ± 0.54; p <0.01) and asymmetric index (9.75 ± 6.63 to 7.01 ± 4.77; p <0.01) also showed improvements. CONCLUSIONS The Nuss procedure may contribute positively to the physical development of patients with pectus excavatum.
{"title":"Effect of the Nuss Procedure on the Physical Development of Patients with Pectus Excavatum.","authors":"H. Kim, J. Y. Yoon, Kook Nam Han, Y. Choi","doi":"10.5761/atcs.oa.16-00012","DOIUrl":"https://doi.org/10.5761/atcs.oa.16-00012","url":null,"abstract":"PURPOSE\u0000This study assessed physical development of patients with pectus excavatum and evaluated the effect of the Nuss procedure on physical development.\u0000\u0000\u0000METHODS\u0000A total of 146 patients underwent the Nuss procedure; of these, at the time of the study, the bar had been removed from 123 patients (84.9%; male 93, female 30) who were eligible for participation in this study. Heights and body weights of patients were measured prior to surgery and immediately before bar removal. Chest computed tomography (CT) was performed preoperatively and immediately before bar removal. The associations between physical development and chest CT indices were evaluated.\u0000\u0000\u0000RESULTS\u0000The height standard deviation score (SDS) was - 0.66 ± 2.23 preoperatively and 0.04 ± 1.34 immediately before bar removal (p <0.01). The weight SDS was - 0.02 ± 2.59 preoperatively; it increased significantly to 0.56 ± 1.56 immediately before bar removal (p <0.01). The Haller index (3.85 ± 1.18 to 2.99 ± 0.54; p <0.01) and asymmetric index (9.75 ± 6.63 to 7.01 ± 4.77; p <0.01) also showed improvements.\u0000\u0000\u0000CONCLUSIONS\u0000The Nuss procedure may contribute positively to the physical development of patients with pectus excavatum.","PeriodicalId":93877,"journal":{"name":"Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90788712","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}
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