The Heart Surgery Forum[JOURNAL]
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200 papers
Nodal Tachycardia Induced By Neostigmine Administration During Off-Pump Coronary Artery Bypass Graft Surgery: What Makes the Difference? A Case Report.
Xuena
Heart Surg Forum · 2023 Apr · PMID 37115002 · Publisher ↗
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...
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.
Massive Pelvic Hematoma After Atrial Septal Defect Closure Via Femoral Vein Cannulation.
Wang S
Heart Surg Forum · 2023 Apr · PMID 37114991 · Publisher ↗
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 t...
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.
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.
Zhang J, Wu M, Zhang X … +3 more , Yang M, Xiong T, Zhi W
Heart Surg Forum · 2023 Mar · PMID 36972603 · Publisher ↗
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), t...
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.
Sternal Reconstruction Using 3D-Printed Titanium Custom-Made Prosthesis for Sternal Dehiscence After Cardiac Surgery.
Intihar U, Železnik J, Brajlih T … +3 more , Drstvenšek I, Hudak R, Antonič M
Heart Surg Forum · 2023 Mar · PMID 36972602 · Publisher ↗
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 printi...
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.
Corrected Transposition of Great Arteries with Cor Triatriatum and Atrial Septal Defect-Case Report.
Meng L, Kong X, Wei K … +3 more , Lv X, Liu C, Bing W
Heart Surg Forum · 2023 Mar · PMID 36972601 · Publisher ↗
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 th...
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.
Surgical Repair of Giant Asymptomatic Ascending Aortic Aneurysm Accompanied with Chronic Stanford Type A Aortic Dissection: A Case Report.
Wang Y, Ren R, Li H … +2 more , Li G, Guo H
Heart Surg Forum · 2023 Mar · PMID 36972600 · Publisher ↗
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...
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.
Better Late Than Never - A Case of a Congenital Left Partial Anomalous Pulmonary Venous Drainage Diagnosed and Treated in The Sixth Decade of Life.
Elbayomi M, Pathare P, Nooh E … +3 more , Harig F, Abdullayev F, Weyand M
Heart Surg Forum · 2023 Mar · PMID 36972599 · Publisher ↗
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., pu...
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.
Prevalence of Coronary Artery Disease in Patients Undergoing Valvular Heart Surgery.
Ren C, Yu J, Zhang J … +7 more , Wang S, Zhu E, Guo H, Sun D, Tang B, Cui H, Lai Y
Heart Surg Forum · 2023 Mar · PMID 36972598 · Publisher ↗
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 c...
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.
Single-Center Retrospective Analysis of Acute Type A Aortic Dissection Outcome and Reoperation Focusing on Extended Versus Limited Initial Repair.
Elbayomi M, Weyand M, Pathare P … +2 more , Nooh E, Harig F
Heart Surg Forum · 2023 Mar · PMID 36972597 · Publisher ↗
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 debat...
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.
Surgery Before Pregnancy in Women with Congenital Heart Disease: A Retrospective Study.
Liu Y, Li Y, Zhang J … +5 more , Li J, Zhao Y, Liu K, Fan X, Wang J
Heart Surg Forum · 2023 Jan · PMID 36856514 · Publisher ↗
BACKGROUND: This study aimed to investigate if surgery before pregnancy would result in better maternal and fetal outcomes in patients with congenital heart disease. METHODS: A retrospective study was conducted using dat...
BACKGROUND: This study aimed to investigate if surgery before pregnancy would result in better maternal and fetal outcomes in patients with congenital heart disease. METHODS: A retrospective study was conducted using data collected from the medical records of pregnant patients with congenital heart disease, who were seen at Beijing Anzhen Hospital between 2010 and 2019. The patients were divided into surgical and non-surgical groups, and the differences in outcomes were compared. RESULTS: A total of 999 patients with congenital heart disease (mean age, 28.7±4.3 years) were enrolled, with 403 (40.0%) and 596 (60.0%) in the surgical and non-surgical groups, respectively. The percentages of almost all adverse events were higher in the non-surgical group than in the surgical group. The adverse events included preterm delivery (9.9 vs. 17.1%), low birth weight (6.5 vs. 11.6%), heart failure (2.7 vs. 6.7%), cesarean section (75.7 vs. 85.9%), pulmonary hypertension (13.6 vs. 36.2%), and death (0.5 vs. 2.3%) (all P < 0.05). A total of 16 (1.6%) patients died, including 14 and two in the non-surgical and surgical groups, respectively. Regardless of the type of congenital heart disease, preterm delivery and low birth weight were more common in the non-surgical group compared with the surgical group, and there were no statistical between group differences in the other remaining events. CONCLUSIONS: In the non-surgical group, the results were similar regardless of the type of congenital heart disease, except for preterm delivery and low birth weight. The overall outcome of the surgical group was better than that of the non-surgical group, and surgery before pregnancy reduced maternal and infant risk.
The Preoperative Uric Acid-to-Albumin Ratio as a New Indicator to Predict Long-Term Prognosis After Surgery for Patients with Acute Type A Aortic Dissection.
Wang X, Deng C, Guo F … +2 more , Zhong L, Gao H
Heart Surg Forum · 2023 Jan · PMID 36856513 · Publisher ↗
BACKGROUND: The long-term prognosis of patients with acute type A aortic dissection (AAD) is poor, despite emergency surgical treatment. Therefore, it is imperative to evaluate patient risk factors to improve the prognos...
BACKGROUND: The long-term prognosis of patients with acute type A aortic dissection (AAD) is poor, despite emergency surgical treatment. Therefore, it is imperative to evaluate patient risk factors to improve the prognosis. The aim of this study was to analyze the ability of the uric acid-to-albumin ratio (UAR) to predict the long-term mortality of patients with type A AAD after surgery. METHODS AND RESULTS: A total of 289 patients with type A AAD who had received surgical treatment was enrolled in this study. Peripheral blood samples were collected before anesthesia induction. All patients were divided into the UAR < 9.875 group and the UAR ≥ 9.875 group, and mortality significantly differed between the two groups. The patients were further divided into survival and non-survival groups, according to whether death occurred after the procedure based on a one-year follow up. Factors, including age, hypertension, albumin, UAR, and D-dimer, differed significantly between the survival and non-survival groups. The independent risk factors for long-term death in patients with type A AAD were analyzed by univariable and multivariable COX regression analyses, and the predictive value of these indices for postoperative mortality was assessed based on the receiver operating characteristic (ROC) curves. Preoperative UAR (HR 1.904, 95% CI, 1.097 to 3.305; P < 0.05), D-dimer (HR, 1.991,95% CI, 1.116 to 3.554; P < 0.05 ), and age (HR 2.216, 95% CI, 1.287 to 3.815; P < 0.05) were identified as independent risk factors for one-year mortality in patients with Type A AAD. The area under the ROC curve (AUC) of UAR was 0.618 [95% (0.544, 0.693)], and the sensitivity and specificity were 69.6% and 51.8%, respectively (P = 0.003). The AUC for albumin was 0.349 [95% (0.274, 0.425)], and the sensitivity and specificity were 26.1% and 51.8%, respectively (P = 0.000), The AUC for uric acid was 0.544 [95% (0.470, 0.619)], and the sensitivity and specificity were 78.3% and 34.5%, respectively (P = 0.265). The AUC for UAR + age + D-dimer was 0.751 [95% (0.681, 0.821)], and the sensitivity and specificity were 76.8% and 68.2%, respectively. CONCLUSIONS: UAR in patients with type A AAD may be used as a new independent risk factor for long-term mortality. Its predictive value is superior to that of albumin or uric acid alone. The combination of UAR, age, and D-dimer provide good prognostic value.
Percutaneous Coronary Intervention as a Bridge Therapy for Aortic Dissection Related Bilateral Coronary Malperfusion: A Case Report.
Chung K, Huang P, Lee K
Heart Surg Forum · 2023 Jan · PMID 36856512 · Publisher ↗
Dealing with coronary arteries caused by aortic dissection remains a great challenge in the treatment of aortic dissection. Here, we present the case of a 57-year-old woman, who initially detected chest pain, and electro...
Dealing with coronary arteries caused by aortic dissection remains a great challenge in the treatment of aortic dissection. Here, we present the case of a 57-year-old woman, who initially detected chest pain, and electrocardiography showed ST-elevation myocardial infarction. After the primary percutaneous coronary intervention, aortic dissection was accidentally detected. She then received central repair and had a satisfactory outcome. We proved that percutaneous coronary intervention as a bridge therapy for aortic dissection-related coronary malperfusion might be efficient.
Postoperative Myocardial Infarction in Acute Type A Aortic Dissection: A Case Report.
Song S, Lu L, Qiang H … +1 more , Wu X
Heart Surg Forum · 2023 Jan · PMID 36856511 · Publisher ↗
Postoperative myocardial infarction (POMI) in acute type A aortic dissection rarely has been reported, we report a case of postoperative myocardial infarction in acute type A aortic dissection, and the clinical presentat...
Postoperative myocardial infarction (POMI) in acute type A aortic dissection rarely has been reported, we report a case of postoperative myocardial infarction in acute type A aortic dissection, and the clinical presentation and possible mechanisms are described. This case illustrates that postoperative myocardial infarction in acute type A aortic dissection is a rare fatal complication in patients without coronary lesions or coronary malperfusion before aortic repair. Type 2 myocardial infarction may account for POMI. Effective treatment may include anticoagulation therapy, volume adjustment, blood pressure support, administration of blood products, heart rate control, and individualized respiratory support.
Management Strategies for Acute Type A Aortic Dissection Complicated By Limb Malperfusion.
Song S, Lu L, Peng H … +5 more , Qiang H, Wang J, Wu Y, Zhuang H, Wu X
Heart Surg Forum · 2023 Jan · PMID 36856510 · Publisher ↗
BACKGROUND: Acute type A aortic dissection complicated by limb malperfusion presents a risk of mortality to the patients. Debates exist regarding management, whether focused on reperfusion first or immediate repair. Here...
BACKGROUND: Acute type A aortic dissection complicated by limb malperfusion presents a risk of mortality to the patients. Debates exist regarding management, whether focused on reperfusion first or immediate repair. Here, we aimed to describe our experience with the management of acute type A aortic dissection (ATAAD) complicated by limb malperfusion. METHODS: From January 1, 2020 to December 31, 2021, 22 consecutive patients were admitted to Xiamen Cardiovascular Hospital, due to acute type A aortic dissection complicated by limb malperfusion. All perioperative variables were recorded and analyzed. Limb malperfusion was diagnosed, according to the clinical symptoms, computed tomography angiography, and laboratory test. We adopted the clinical categories of acute limb ischemia to stratify severity of limb ischemia. Surgery strategies are as follows: Reperfusion first followed by central repair, immediate central repair, and immediate central repair followed by stenting. RESULTS: There were 21 males and one female with an average of 53.3±11.7 years. Management strategies were as follows: immediate central repair using total arch replacement with frozen elephant trunk in 15 patients, endovascular stenting followed by central repair in four patients, and endovascular stenting after central repair in two patients. The average extracorporeal circulation time was 258.8 ± 70.5 min; the average aortic cross-clamp time was 177.9 ± 54.2 min; and the average circulatory arrest time was 45.5 ± 13.1 min. The early mortality rate was 13.6% (3/22). Two patients left the hospital voluntarily, due to cerebral infarction and bleeding. One patient underwent fasciotomy for osteofascial compartment syndrome and uneventfully was discharged. Six patients underwent continuous renal replacement therapy and hemoperfusion. CONCLUSION: Central repair is safe and feasible for ATAAD complicated with limb malperfusion. For serious limb malperfusion, endovascular stenting followed by central repair is a good choice with continuous renal replacement therapy (CRRT) and hemoperfusion. Hospital mortality rate is high in cases with multiple organ malperfusion.
Amlodipine and Atropine for Hypoxia During One-Lung Ventilation: A Case Report.
Liu S, Zhang X
Heart Surg Forum · 2023 Jan · PMID 36856509 · Publisher ↗
Anesthetists are concerned about the causes and management of hypoxia during one-lung ventilation (OLV). Here, we report a hypoxic case during OLV and video-assisted thoracic surgery (VATS) for pulmonary lobectomy. The p...
Anesthetists are concerned about the causes and management of hypoxia during one-lung ventilation (OLV). Here, we report a hypoxic case during OLV and video-assisted thoracic surgery (VATS) for pulmonary lobectomy. The preoperative management of hypertension with amlodipine was considered to be responsible for the hypoxia. As a calcium channel blocker, amlodipine may inhibit hypoxic pulmonary vasoconstriction (HPV) and contribute to the reduction of the ventilation/perfusion ratio (or V/Q ratio). The hypoxia efficiently was treated by atropine, where both tracheal effects and the enhancement of HPV through muscarinic receptor blocking may work. For patients undertaking OLV, the effects of calcium channel blockers as a potential cause for hypoxemia should be paid attention to, where atropine administration may be of clinical benefit. One-lung ventilation (OLV) generally is used during anesthesia for thoracic surgeries. For OLV, a double-lumen tracheal tube (DLT) is used to realize lung separation in the airway. This technique is essential because it facilitates the surgical performance as well as isolates a healthy lung from the pathologic one. However, there are some concerns for OLV during anesthesia, where hypoxemia is commonly seen. There are many causes for hypoxemia during OLV. These include, for example, reduced oxygen stores due to the collapse of the non-ventilation lung, ventilation-perfusion mismatch induced by both lateral positions, and decrease in elastic recoil leading to more atelectasis. Accordingly, management of hypoxemia during OLV generally have been applied. Increase fraction of inspiration O2 (Fi O2) to 1, double checking the position of DLT, applying positive end expiratory pressure (PEEP), optimizing cardiac output (CO) all have been proven to be effective. Here, we report an efficiently treated hypoxemia case using atropine during video-assisted thoracic surgery (VATS) for pulmonary lobectomy. Preoperative medication of amlodipine may contribute to the hypoxemia through attenuating HPV during OLV, which may be antagonized by possible HPV augmentation of atropine. Further investigation is therefore suggested.
Aortic Valve Neocuspidization Procedure Provides Better Postoperative Outcomes When Compared to Rapid Deployement Aortic Valves.
Karabacak K, Kubat E, Kadan M … +7 more , Asil S, Erol G, Demirkiran T, Firtina S, Doğanci S, Ince ME, Bolcal C
Heart Surg Forum · 2023 Jan · PMID 36856508 · Publisher ↗
BACKGROUND: The aim of this study was to compare the early results of rapid deployment aortic valves (RD-AVR) and aortic valve neocuspidization (AVNeo) techniques. METHODS: Between December 2019 to May 2022, 104 patients...
BACKGROUND: The aim of this study was to compare the early results of rapid deployment aortic valves (RD-AVR) and aortic valve neocuspidization (AVNeo) techniques. METHODS: Between December 2019 to May 2022, 104 patients were operated on with aortic stenosis by RD-AVR (N = 52) and AVNeo (N = 52) techniques. Patients with isolated aortic valve stenosis and aortic stenosis concomittant with planned other cardiac surgeries were included. RESULTS: The mean age of patients in the RD-AVR and AVNeo groups were 67.4 ± 7.8 vs. 62.9 ± 8.7, respectively. Aortic cross-clamp time in the RD-AVR group was 56.7 ± 23.3 minutes, while it was 104.1 ± 27.9 minutes in the AVNeo group (P < 0.001). Cardiopulmonary bypass time in the RD-AVR group and in the AVNeo group was 89.8 ± 27.6 minutes and 141.8 ± 36.7 minutes, respectively (P < 0.001). Permanent pacemaker become necessary in four patients in the RD-AVR group secondary to type 2 AV block. Paravalvular leak was observed in six patients, who underwent RD-AVR, while grade 2 central aortic regurgitation was observed in one patient in the AVNeo group. Hospital mortality was 8% in the RD-AVR group and 6% in the AVNeo group (P = 0.696). CONCLUSIONS: AVNeo procedure is a feasible technique in all age groups of patients with successful hemodynamic results in the early postoperative period and with the advantage of not requiring anticoagulants. It also can be applied with other cardiac surgical interventions.
Risk Factors for Poor Prognosis in Acute Coronary Syndrome Admitted in the Emergency Department: A Retrospective Cohort Study.
Ke J, Chen Y, Wang X … +4 more , Wu Z, Zhang Q, Lian Y, Chen F
Heart Surg Forum · 2023 Feb · PMID 36856507 · Publisher ↗
BACKGROUND: In the present study, we aimed to identify risk factors of poor prognosis for patients with acute coronary syndrome in the emergency department. METHODS: The study included 2667 patients, who were admitted to...
BACKGROUND: In the present study, we aimed to identify risk factors of poor prognosis for patients with acute coronary syndrome in the emergency department. METHODS: The study included 2667 patients, who were admitted to the Emergency Department of Chest Pain Center, Fujian Provincial Hospital, due to chest pain from January 1, 2017 to March 31, 2020. Logistic regression was used to identify factors of poor prognosis for patients with ACS in the ED. Receiver operating characteristic (ROC) curve was plotted to assess the performance of the multivariate logistic regression model. Subgroup analysis was used to analyze the difference of SBP in ACS patients with different characteristics. RESULTS: The final analysis included 2667 patients, of whom 2,057 patients (77.8%) had poor prognosis. STEMI (compared with UA) (OR=20.139; 95% CI:12.448-32.581; P < 0.001), NSTEMI (compared with UA) (OR=7.430; 95% CI:5.159-10.700; P < 0.001), respiratory rate ≥20 bpm (compared with <20 bpm) (OR=1.334; 95% CI: 1.060-1.679; P = 0.014), and use of antiplatelets (OR=1.557; 95% CI:1.181-2.053; P = 0.002) was associated with increased likelihood of poor prognosis for ACS patients in ED. SBP ≥140 mmHg (compared with<140mmHg) (OR=0.574; 95% CI: 0.477-0.690; P < 0.001) was associated with decreased likelihood of poor prognosis for ACS patients in the ED. The area under curve (AUC) of the predictive efficacy of logistic regression model was 0.825 (95% CI: 0.795-0.833, P < 0.001). CONCLUSION: This study found that STEMI, NSTEMI, respiratory rate ≥20 bpm, and use of antiplatelets were associated with increased likelihood of poor prognosis for ACS patients in the ED. It also found that SBP≥140 was associated with decreased likelihood of poor prognosis. Our study may be useful for doctors to make clinical decisions for ACS patients.
Recurrent HeartMate 3 Right Ventricular Assist Device Stoppages in a Biventricular Assist Device Carrier.
Gasparovic H, Tokic T, Cikes M … +7 more , Urlic M, Kopjar T, Cerina P, Knezevic I, Perkov D, Milicic D, Biocina B
Heart Surg Forum · 2023 Jan · PMID 36856506 · Publisher ↗
A 44-year-old female patient with chemotherapy-induced cardiomyopathy presented with acute cardiogenic shock requiring ECMO support. Multiple failed weaning trials from temporary mechanical circulatory assistance prompte...
A 44-year-old female patient with chemotherapy-induced cardiomyopathy presented with acute cardiogenic shock requiring ECMO support. Multiple failed weaning trials from temporary mechanical circulatory assistance prompted a transition to staged durable biventricular support. Her course was complicated with recurrent RVAD stoppages. The initial event was treated with pump exchange, while for the subsequent RVAD standstill, we employed a device wash-out and reimplantation strategy. A brief period of circulatory arrest was employed to explore the right-sided cardiac chambers using a single-use bronchoscope.
Effects of Percutaneous Coronary Intervention and Coronary Artery Bypass Grafting on Clinical Outcomes in Patients with Reduced Ejection Fraction Heart Failure and Coronary Heart Disease: A Meta-Analysis.
Yu ZX, Yan J, Wang MY … +5 more , Chen R, Luo JY, Li XM, Xie X, Ma YT
Heart Surg Forum · 2023 Feb · PMID 36856505 · Publisher ↗
OBJECTIVE: To clarify the effects of percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) on the clinical outcomes of patients with coronary heart disease (CHD) complicated with reduced eje...
OBJECTIVE: To clarify the effects of percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) on the clinical outcomes of patients with coronary heart disease (CHD) complicated with reduced ejection fraction heart failure (HFrEF) through meta-analysis. METHODS: Three major literature databases - PubMed, Web of Science, and Cochrane - were searched by search terms and the literature retrieval time was publications dating from January 2007 to December 2021. To search for observational studies and randomized controlled trials (RCT) comparing the efficacy of PCI and CABG in patients with CHD and HFrEF, the abstract or full text of the literature was read and the final included literature was determined, according to inclusion and exclusion criteria. The quality of the included literature was evaluated using the Ottawa scale and data extraction was further completed. Data analysis was made using RevMan5.4 and R4.1 software; relevant forest plots and funnel plots were made, according to the extracted data. Egger's test was used to evaluate whether the data had publication bias. Outcomes were the major adverse cardiovascular events (MACE). RESULTS: A total of 10 studies were included and 11,032 subjects were included, made up of 5,521 cases of PCI and 5,511 cases of CABG. The results showed no significant difference between the two groups in cardiac mortality (CM) (RR=1.13, 95% CI 0.98-1.30, P = 0.10) and in overall all-cause mortality (ACM) (RR=1.12, 95% CI 0.92-1.37, P = 0.25). In the subgroup analysis of ACM, in the subgroups with left ventricular ejection fraction (LVEF) less than 35% and exceeding 35% and less than 50% (RR=1.12, 95% CI 0.92-1.37, P = 0.25) between the two groups, there was no statistical difference. However, among other MACE, compared with the PCI group, the CABG group had a lower risk of MACE (RR=1.58, 95%CI 1.49-1.70, P < 0.00001), myocardial infarction (MI) (RR=1.99, 95% CI 1.02-3.88, P = 0.04), heart failure (HF) (RR=1.29, 95% CI 1.17-1.43, P < 0.00001) and revascularization (RR=2.74, 95% CI 1.93-3.90, P < 0.00001). Finally in the CABG group, the risk of stroke or transient ischemic attack (TIA) was higher (RR=0.71, 95% CI 0.58-0.86, P = 0.0006) than the PCI group. CONCLUSIONS: The mortality rates of PCI and CABG were similar in patients with CHD complicated with HFrEF. Compared with PCI, CABG had a lower incidence of MACE, MI, HF, and revascularization, and a higher incidence of stroke or TIA.
Intraoperative Type B Aortic Dissection during Total Arch Replacement.
Machii Y, Shimada N, Kitashima F … +1 more , Tanaka M
Heart Surg Forum · 2023 Feb · PMID 36856504 · Publisher ↗
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 c...
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.
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