The Heart Surgery Forum[JOURNAL]
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200 papers
Compression of the Pulmonary Artery and Coronary Artery Caused by Pulmonary Epithelioid Hemangioendothelioma: A Case Report.
Zhang H, Luo Q, Xie N … +1 more , Zou L
Heart Surg Forum · 2023 Feb · PMID 36856503 · Publisher ↗
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 o...
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.
Minimally Invasive Direct Coronary Artery Bypass Versus Percutaneous Coronary Intervention for Isolated Left Anterior Descending Artery Stenosis: An Updated Meta-Analysis.
Zhang S, Chen S, Yang K … +8 more , Li Y, Yun Y, Zhang X, Qi X, Zhou X, Zhang H, Zou C, Xiaochun Ma
Heart Surg Forum · 2023 Feb · PMID 36856502 · Publisher ↗
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 interventi...
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.
Efficacy of Hemoperfusion Cartridge Procedure on Patients Undergoing Cardiac Valve Replacement Surgery with Cardiopulmonary Bypass.
Yang K, Huang H, Dai R … +7 more , He S, Zhang J, Wu F, Wei X, Gao F, Wu X, Xin M
Heart Surg Forum · 2023 Jan · PMID 36856501 · Publisher ↗
OBJECTIVES: Cardiopulmonary bypass (CPB) induces inflammatory homeostasis dysregulation, closely related to many postoperative adverse effects. Minimizing the systemic inflammatory response to CPB is imperative to improv...
OBJECTIVES: Cardiopulmonary bypass (CPB) induces inflammatory homeostasis dysregulation, closely related to many postoperative adverse effects. Minimizing the systemic inflammatory response to CPB is imperative to improving cardiac surgery safety. This study aimed to retrospectively evaluate the efficacy of the hemoperfusion cartridge, a device recently designed for extracorporeal blood purification to remove cytokines from the blood for patients undergoing cardiac valve replacement surgery using CPB. METHODS: The hemoperfusion (HP) group consisted of 138 patients, who underwent a hemoperfusion cartridge procedure during CPB. The control group included 149 patients, who received standard CPB management. The evaluated indices included inflammatory cytokines, blood biochemical indices, and postoperative outcome indices. RESULTS: Patients in the HP group had relatively lower interleukin (IL)-6 levels (days one and two post-CPB) and IL-8 (day one post-CPB) compared with the control group. Some relatively decreased biochemical blood indices also were observed in the HP group, including a significantly lower lactic acid level (days one, two, and three post-CPB), platelet counts (days one, two, and three post-CPB), and aspartate aminotransferase (days one and three post-CPB). Regarding the postoperative outcomes, no severe complications occurred in the patients; however, the HP group required less ventilation time than the control group. CONCLUSIONS: The hemoperfusion cartridge seems promising in limiting the inflammatory reactions during CPB, with noteworthy potential for application in cardiac surgery.
Association of Critical Value With 28-Day Mortality After Cardiac Surgery.
Xu H, Xue YY, Shen X … +2 more , Hong L, Zhang C
Heart Surg Forum · 2023 Feb · PMID 36856500 · Publisher ↗
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 asso...
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.
Prediction of no reflow phenomenon in percutaneous coronary intervention with optical coherence tomography and analysis of risk factors.
Gui S, Fu G, Jia M … +3 more , Liu S, Jia X, Jian L
Heart Surg Forum · 2023 Feb · PMID 36856499 · Publisher ↗
Objective :To investigate the predictive value of no reflow phenomenon in interventional therapy by measuring plaque quantitatively with optical coherence tomography (OCT). Methods:196 patients with acute ST segment ele...
Objective :To investigate the predictive value of no reflow phenomenon in interventional therapy by measuring plaque quantitatively with optical coherence tomography (OCT). Methods:196 patients with acute ST segment elevation myocardial infarction who visited the Department of Cardiology of the Second Affiliated Hospital of Zhengzhou University from January 2020 to January 2022 were selected as the study objects. According to whether there was no reflow during the operation, they were divided into no reflow group (46 cases) and normal flow group (150 cases). Systematically collect general clinical data and coronary angiography related data of patients through inpatient cases, measure fiber cap thickness and lipid core angle of diseased vascular plaque through optical coherence tomography, and analyze the relationship between fiber cap thickness and no reflow phenomenon Results:BMI, LDL, phospholipase A, the proportion of family history of coronary heart disease, and the thrombus load in the no reflow group were higher than those in the normal flow group (P<0.05), while the thickness of the fibrous cap was lower than that in the normal flow group (P<0.05); Further multivariate logistic regression analysis showed that fiber cap thickness, phospholipase A and severe thrombosis load were independent risk factors for non reflow phenomenon (P<0.05); Further ROC curve analysis found that the thickness of fiber cap had a high predictive value for no reflow phenomenon, and the best cutoff value for no reflow was 95, AUC: 0.926 (95% CI: 0.891-0.961, P<0.001). Conclusions: Optical coherence tomography can predict the occurrence of no reflow phenomenon by measuring the fiber cap thickness quantitatively. The prediction effect is the best when the fiber cap thickness is 95.
Effect of Individualized Cardiac Rehabilitation on Cardiac Function, Time Consumption, and Quality of Life in Patients After CABG.
Guan HQ, Hang C, Zhang M … +2 more , Yuan LY, Ding YJ
Heart Surg Forum · 2023 Feb · PMID 36856498 · Publisher ↗
BACKGROUND: To investigate the effect of individualized cardiac rehabilitation (CR) on cardiac function, time consumption, and quality of life (QoL) in post-CABG patients. METHODS: Two different CR strategy: basic rehabi...
BACKGROUND: To investigate the effect of individualized cardiac rehabilitation (CR) on cardiac function, time consumption, and quality of life (QoL) in post-CABG patients. METHODS: Two different CR strategy: basic rehabilitation and individualized rehabilitation was designed. The patients were screened and randomized into the two groups: the basic rehabilitation group (BRG) and individualized rehabilitation group (IRG). Data, such as clinical characteristics, LVEF, 6MWD (6-min walk distance), BNP, LVEDD (left ventricular end diastolic dimension), SF-36 score, and time consumption were collected and recorded. RESULTS: There was no difference between the IRG and BRG patients in the clinical characteristics. The 6MWD and LVEF on post-op significantly were higher, while BNP and LVEDD significantly was lower in the IRG than in BRG. The time to first out-of-bed activity, ICU stay time, and post-op hospital stay time of the IRG in post-op was significantly shorter than BRG. The IRG patients scored significantly higher on the SF-36. CONCLUSION: Individualized CR is safe and can reduce the time consumption and improve the cardiac function and QoL of patients undergoing CABG.
Clinical Electrophysiological Features and Radiofrequency Ablation of Patients with Atrial Fibrillation.
Yao Q, Han L, Wang J … +2 more , Zhang Q, Wang Z
Heart Surg Forum · 2023 Feb · PMID 36856497 · Publisher ↗
This study aimed to investigate electrophysiological features of radiofrequency ablation surgery in patients with the atrial fibrillation (AF). Fifty patients were included in this study and evenly divided, with 25 AF pa...
This study aimed to investigate electrophysiological features of radiofrequency ablation surgery in patients with the atrial fibrillation (AF). Fifty patients were included in this study and evenly divided, with 25 AF patients in the experiment group and 25 patients with arrhythmias in the control group. General clinical materials in the two groups were collected. Then, patient number of pulmonary vein antrum potential trial, intra-right atrial conduction time, intra-left atrial conduction time, interatrial conduction time, conduction time between atrium, and pulmonary veins trials were utilized to measure the efficacy of radiofrequency ablation surgery in patients with AF and clarify the relationship between AF and electrophysiological features in the atrium and pulmonary veins. Our study findings showed that conduction time interval between the atrium and pulmonary veins trial by radiofrequency ablation surgery were significantly less than those in pre-treatment AF patients. We can conclude that radiofrequency ablation surgery can effectively treat AF patients by relieving the electrophysiological dysfunction, and radiofrequency ablation can be used to prevent the development of AF.
Effect of Defecation Delay in Patients After Tricuspid Valve Replacement: A Retrospective Study.
Chen Q, Li N, Qin M … +6 more , Xu X, Zhong K, Lu F, Li B, Han L, Xu Z
Heart Surg Forum · 2023 Feb · PMID 36856496 · Publisher ↗
BACKGROUND: Defecation delay is a common symptom in patients after tricuspid valve replacement (TVR). Previous studies have demonstrated that defecation delay was associated with worse clinical outcomes of critically ill...
BACKGROUND: Defecation delay is a common symptom in patients after tricuspid valve replacement (TVR). Previous studies have demonstrated that defecation delay was associated with worse clinical outcomes of critically ill patients. Our study aimed to investigate the incidence and risk factors of defecation delay in patients after TVR and its adverse clinical outcomes. METHODS: A retrospective study was conducted in 206 patients undergoing TVR under cardiopulmonary bypass from May 2005 to July 2021. According to the first postoperative defecation time after surgery, patients were divided into the delayed group (>3 days) and control group (≤3 days). Baseline characteristics and preoperative, intraoperative, and postoperative data were collected to investigate the clinical outcomes of defecation delay. RESULTS: Among the 206 patients, 51.9% (107/206) cases were classified into the defecation delay group. Univariate analysis showed that age (P = 0.043), preoperative platelets (PLT) (P < 0.001), cardiopulmonary bypass (CPB) time (P = 0.013), minimum rectal temperature (P = 0.042), and the use of prokinetic drugs (P = 0.015) were significantly different in the two groups. In addition, the perioperative adverse events in the defecation delay group were significantly higher than that of the control group. Logistic regression analysis indicated that the mortality of patients was associated with postoperative renal dysfunction (P = 0.047) and postoperative respiratory failure (P = 0.004) but was not associated with defecation delay (P > 0.05). CONCLUSION: Patients with defecation delay after TVR were more likely to appear adverse events, however, defecation delay was not associated with mortality after TVR.
Patient With Takayasu Arteritis Treated with the Ozaki Procedure and Ascending Aorta Replacement.
Chen F, Wang X, Zhuang X … +2 more , Zhang WZ, Guo H
Heart Surg Forum · 2023 Feb · PMID 36856495 · Publisher ↗
Due to the specific pathogenesis of Takayasu arteritis, complicated with aortic valve disease, surgical treatment always has been a difficult problem. We report a 26-year-old female patient with Takayasu arteritis who wa...
Due to the specific pathogenesis of Takayasu arteritis, complicated with aortic valve disease, surgical treatment always has been a difficult problem. We report a 26-year-old female patient with Takayasu arteritis who was treated with the Ozaki procedure for aortic valve disease and replacement of the ascending aorta with a straight synthetic graft. The surgery achieved satisfactory early results.
A Retrospective Multicenter Experience: Does Packing the Surgical Field Help to Stop Bleeding After Cardiac Surgery.
Ahmed A, Yehia A, Toema A
Heart Surg Forum · 2023 Feb · PMID 36856494 · Publisher ↗
BACKGROUND: Intractable bleeding after cardiac surgery is a well-documented complication. When conservative measures fail to control bleeding, re-exploration is required, and, in some cases, chest packing may be needed....
BACKGROUND: Intractable bleeding after cardiac surgery is a well-documented complication. When conservative measures fail to control bleeding, re-exploration is required, and, in some cases, chest packing may be needed. METHODS: The study included 148 patients admitted to eight cardiac surgery centers in Egypt with severe postoperative bleeding. All patients underwent chest re-exploration and chest packing to control postoperative bleeding. RESULTS: The mean age was 62.7 ± 5.6 years. Their mean BMI was 27.1 ± 3.9 kg/m2. One-hundred-ten (74.3%) of included patients were hypertensive, while 49 (33.1%) patients were diabetic. Twenty-seven (18.2%) patients had initially had a triple valve replacement. Sepsis was prevalent among 31 (20.9%) of included patients. Twenty (13.5%) patients died. CONCLUSION: Intractable bleeding is a well-documented complication following cardiac surgery. Chest re-exploration is required in certain situations when the traditional conservative options fail to stop bleeding. Chest packing is a modality that can be considered to control bleeding in certain situations.
Comparison of Pericardial and Prosthetic Rings for Mitral Repair: Are Pericardial Rings Durable in the Mid- to Long-Term Follow Up?
Biçer M, Kehlibar T, Elibol A … +5 more , Günay R, Kozan Ş, Ceylan L, Yılmaz M, Ketenci B
Heart Surg Forum · 2023 Feb · PMID 36856493 · Publisher ↗
BACKGROUND: While prosthetic rings are commonly used for mitral valve repairs, autologous pericardium is an alternative ring material that can be used in these procedures. In this report, we aim to present a comparison o...
BACKGROUND: While prosthetic rings are commonly used for mitral valve repairs, autologous pericardium is an alternative ring material that can be used in these procedures. In this report, we aim to present a comparison of two types of rings used for mitral repair. METHODS: Between January 2005 and January 2009, 107 patients who underwent mitral valve repair surgery were analyzed. Patients were divided into two groups, according to the type of ring that was used for mitral annular stabilization. Glutaraldehyde-treated pericardial rings were used for 31 patients (group 1), whereas prosthetic rings were used for 76 patients (group 2). Survival, freedom from reoperation, recurrent mitral regurgitation, and the effects of rheumatic mitral disease on these parameters were evaluated and compared for both groups. RESULTS: Follow-up time for our cohort was 4.24±0.4 years. There were four and seven late mortalities in groups 1 and 2, respectively, and five reoperations in each group. There was no significant difference between the groups, in terms of survival, freedom from reoperation, and recurrent mitral regurgitation (log-rank analyses for both groups were P = 0.777, P = 0.346, and P = 0.781, respectively). There was no significant difference in freedom from reoperation and recurrent mitral regurgitation for both groups, in terms of underlying rheumatic valvular disease and other types of pathology. CONCLUSION: Pericardial ring annuloplasty shows to be a considerable alternative technique for mitral valve repair procedures in the mid- to long-term follow up. Rheumatic mitral valves had poor outcomes, when compared with other types of structural valvular pathologies in cases where pericardial rings were used in the repair procedure.
Sternal Wound Infection Following Open Heart Surgery: Incidence, Risk Factor, Pathogen, and Mortality.
Al-Ebrahim K, Alsheikh A, Ramadan SA … +5 more , Alshehri A, Aljohani B, Rami A, Khared M, Alzahrani A
Heart Surg Forum · 2023 Feb · PMID 36856492 · Publisher ↗
BACKGROUND: Due to its high morbidity and mortality after open-heart surgery, sternal wound infection (SWI) is one of the most important consequences to avoid and manage. AIM: To assess the incidence, risk factor, causat...
BACKGROUND: Due to its high morbidity and mortality after open-heart surgery, sternal wound infection (SWI) is one of the most important consequences to avoid and manage. AIM: To assess the incidence, risk factor, causative organisms, and mortality of SWIs in patients who had open-heart surgery over a 9-year period at King Abdulaziz University Hospital, Jeddah, Saudi Arabia. METHODS: A retrospective study was done on 634 patients who underwent open heart surgery. Data was collected, including patient demographics, BMI, blood group, diabetes, hyperlipidemia, COPD, previous cardiac surgery, previous myocardial infarction, duration of the operation, blood transfusion during the operation, hospital length of stay, and bypass time with each type of sternal wound infection. RESULTS: The incidence of SSWI and DSWI was 8.6% and 4.1%, respectively. Coagulase-negative staphylococcus was the most frequently isolated organism from SSWI and DSWI patients. A concomitant diabetes mellitus that necessitates blood transfusion was identified as one of the risk variables for SSWI in a multivariate regression study. While concomitant diabetes, being a woman, and a lengthy hospital stay were independently linked with DSWI. Compared with the SSWI group, the 30-day mortality rate for DSWI patients was 3.8% as opposed to 3.7%, and the difference in survival was not statistically significant. Having an older, longer bypass time, and postoperative problems were independent risk factors for 30-day mortality. CONCLUSION: Future studies in various healthcare settings are required in order to generalize the results because this was a single center study.
Identification of Prognostic Factors for Recurrence and Mortality in Patients With Acute Pulmonary Embolism.
Zeng W, Xu B, Wang X … +5 more , Lin S, Lin Q, Hao Z, Chen F, Ke J
Heart Surg Forum · 2022 Dec · PMID 36602509 · Publisher ↗
BACKGROUND: This study aimed to explore prognostic factors for 1-year recurrence and mortality in patients with acute pulmonary embolism (APE). METHODS: APE patients who attended the Emergency Department of Fujian Provin...
BACKGROUND: This study aimed to explore prognostic factors for 1-year recurrence and mortality in patients with acute pulmonary embolism (APE). METHODS: APE patients who attended the Emergency Department of Fujian Provincial Hospital from January 2016 to June 2020 were recruited. Univariate and multivariate logistic regression analyses were carried out to determine the prognostic factors for 1-year recurrence and mortality. RESULTS: A total of 458 APE patients were included, of whom 81 (17.69%) had recurrence, and 97 (21.18%) died. Multivariate logistic regression analyses revealed that smoke (OR: 1.949; 95% CI: 1.094-3.470; P = 0.023), abnormal platelet distribution width (OR: 3.013; 95% CI: 1.574-5.767; P = 0.001), and interrupted maintenance therapy (OR: 18.280; 95% CI: 9.777-34.179; P < 0.001) were significantly associated with an increased risk of 1-year recurrence in APE patients. Age ≥65 years (OR: 3.492; 95% CI: 1.876-6.500; P < 0.001), history of malignancy (OR: 7.190; 95% CI: 3.804-13.587; P < 0.001), history of long-term immobilization (OR: 6.244; 95% CI: 3.472-11.228; P < 0.001), mechanical ventilation (OR: 5.971; 95% CI: 3.154-11.304; P < 0.001), and interrupted maintenance therapy (OR: 2.414; 95% CI: 1.315-4.432; P = 0.004) were independent prognostic factors for 1-year mortality. The AUC of 1-year mortality and recurrence prediction models were 0.852 (95% CI: 0.805-0.898) and 0.868 (95%CI: 0.832-0.905). CONCLUSION: In patients with APE, history of smoking, abnormal PDW, and interrupted maintenance therapy were significantly associated with the risk of 1-year recurrence, while age ≥65 years, history of malignancy, history of long-term immobilization, mechanical ventilation, and interrupted maintenance therapy were independent prognostic factors for 1-year mortality.
Aortic Repair Through a Left Thoracotomy in a 12-Year-Old Child with Traumatic Aortic Pseudoaneurysm: A Case Report.
Wang K, Xu W, Wang C … +3 more , Hu J, Tan S, Fan X
Heart Surg Forum · 2022 Dec · PMID 36602508 · Publisher ↗
Traumatic pseudoaneurysm of the descending aorta is a rare but life-threatening disease, especially in children. Open surgical replacement and thoracic endovascular repair in treating traumatic pseudoaneurysm to prevent...
Traumatic pseudoaneurysm of the descending aorta is a rare but life-threatening disease, especially in children. Open surgical replacement and thoracic endovascular repair in treating traumatic pseudoaneurysm to prevent aortic rupture rarely have been reported in children. Here, we present a rare case of aortic pseudoaneurysm caused by trauma in a 12-year-old child treated with an alternative surgical strategy. Aortic repair without an implant assisted by distal perfusion was performed through a left thoracotomy. The child satisfactorily recovered, was discharged, and remained in a good condition during the follow-up period.
Effect of Dexmedetomidine on Inflammatory Response in Aortic Dissection.
Gao L, Jin B, Shen J … +1 more , Zhang X
Heart Surg Forum · 2022 Dec · PMID 36602507 · Publisher ↗
OBJECTIVE: To study the effect of dexmedetomidine (Dex) on perioperative inflammatory response in aortic dissection (AD) patients. METHODS: From June 2020 to June 2022, 50 patients with Stanford type B AD underwent endov...
OBJECTIVE: To study the effect of dexmedetomidine (Dex) on perioperative inflammatory response in aortic dissection (AD) patients. METHODS: From June 2020 to June 2022, 50 patients with Stanford type B AD underwent endovascular stent-graft exclusion (EVAR) at our hospital. They randomly were assigned to two groups (N = 25): the control group (C group) and the Dex group. Patients in the Dex group received 0.5ug/kg Dex intravenously 10 minutes before induction of anesthesia and 0.5µg/kg/h Dex during the intervention until 15 minutes before the end of surgery. In contrast, the C group received the same volume of normal saline at the same time points. The two groups were induced and maintained with the same anesthetic agents. Venous blood samples were taken 3 days before operation (T1), 1 day before operation (T2), 1 day after operation (T3) and 3 days after operation (T4) to detect levels of C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and white blood cell count (WBC). RESULTS: At T3 and T4, CRP and ESR in the Dex group were significantly improved compared with those in the C group. CONCLUSION: Dexmedetomidine can reduce the inflammatory reaction of aortic dissection.
Acute Type A Aortic Dissection and Coarctation: Single-Stage Repair Using a Clamshell Incision and a Systematic Literature Review.
Iosifescu AG, Timișescu AT, Prodan B … +2 more , Popescu A, Iliescu VA
Heart Surg Forum · 2022 Dec · PMID 36602506 · Publisher ↗
BACKGROUND: Aortic coarctation (CoAo) may be discovered only when complicated by acute type A aortic dissection (ATAAD). We present a case with a one-stage repair of this pathologic association and review the relevant li...
BACKGROUND: Aortic coarctation (CoAo) may be discovered only when complicated by acute type A aortic dissection (ATAAD). We present a case with a one-stage repair of this pathologic association and review the relevant literature focusing on the surgical choices. CASE REPORT: A 43-year-old man presented with acute thoracic pain. Computed tomography and echocardiography demonstrated CoAo, ATAAD type II, an ascending aorta aneurysm, and moderate regurgitation of a bicuspid aortic valve. Emergency surgery was performed. A clamshell incision, cardiopulmonary bypass with dual arterial cannulation (axillo-femoral), CoAo repair (by resection-interposition), and supracoronary aorta replacement were performed. Four years later, the patient was healthy and asymptomatic. REVIEW: Thirty surgical cases of ATAAD with CoAo repair after the dissection onset were included. Iatrogenic dissections and formerly repaired CoAo without surgical indication were excluded. RESULTS: The mean patient age was 27.8 ± 12 years; there was a male predominance (76.7%). The patients frequently presented with ascending aorta aneurysm (86.2%), bicuspid aortic valve (69%), and type II dissection (79.3%); dissection never extended below the CoAo. The one-stage treatment (15 patients; 55.5%) included 12 surgical repairs of CoAo (mostly by ascending-to-descending aorta extra-anatomic bypass; 58.3%) and three balloon angioplasties. In patients with uncorrected CoAo at the onset of cardiopulmonary bypass, double arterial perfusion was used in 55.5%. CONCLUSIONS: One-stage repair (hybrid or surgical), double arterial perfusion, and extra-anatomic ascending-to-descending aorta bypass are the most common options for treating ATAAD-CoAo. The clamshell incision provides excellent access for an extended arch procedure and facilitates anatomic isthmus repair.
The The Impact of Surgical Revascularization on Cardiac Function and Mitral Regurgitation in Patients with Coronary Artery Disease: An Intermediate-Term Single-Center Experience.
Mufti H, Bamsallm M, Almalki A … +5 more , Aljefri A, Alnejadi W, Neyaz A, Al Bugami S, Al Rahimi J
Heart Surg Forum · 2022 Dec · PMID 36602505 · Publisher ↗
INTRODUCTION: Ischemic heart disease is the most common cause of death worldwide. Coronary artery bypass grafting (CABG) is the most performed cardiac surgical procedure. Studies have shown that CABG can have a beneficia...
INTRODUCTION: Ischemic heart disease is the most common cause of death worldwide. Coronary artery bypass grafting (CABG) is the most performed cardiac surgical procedure. Studies have shown that CABG can have a beneficial effect on left ventricular ejection fraction (LVEF) and ischemic mitral regurgitation (IMR) without intervention on the mitral valve. This study aims to assess changes in LVEF and IMR after CABG in our population. METHODS: We retrospectively reviewed charts of patients who underwent only CABG at King Faisal Cardiac Center in Jeddah between January 2016 and December 2019 (N = 298). Pre- and postoperative echocardiography data were evaluated. Changes in cardiac function and mitral regurgitation were analyzed. RESULTS: CABG was performed on 298 patients. The median age was 61 years (interquartile range (IQR)= 54-68), and 78.5% of the patients were male. The median body mass index was slightly higher in females (32.9 vs. 28.6 kg/m2, P = 0.089). Approximately 81% of patients had diabetes and hypertension, but only 24% were active smokers. The median time between pre- and postoperative echocardiography was 8 months (IQR= 3-17). The median preoperative LVEF was 51% (IQR= 44.1-57.9), and 75% of patients had normal-to-mild MR. The median postoperative EF was not different among patients who underwent echocardiography within or after 6 months (53.1% and 50.3%, respectively, P = 0.454). None of the patients progressed to severe MR after surgery, and only 2.7% had moderate-to-severe MR at follow up. Postoperative in-hospital mortality was 0.7%. CONCLUSION: Based on international guidelines and the best evidence, surgical revascularization is sufficient for patients with coronary artery disease (CAD) with moderate IMR and is not associated with LVEF worsening or MR progression. Complete revascularization might have an influence on ventricular recovery that might improve or stabilize IMR. Our results are consistent with larger studies reporting very low postoperative mortality of this high-risk patient group.
A Rare Case of Primary Malignant Pericardial Mesothelioma Diagnosed with Pericardiotomy.
Cui F, Hu Y, Li Y
Heart Surg Forum · 2022 Dec · PMID 36602504 · Publisher ↗
Primary malignant pericardial mesothelioma (PMPM) is an extremely rare and lethal cardiac tumor. This article presents a 62-year-old man with recurrent pericardial fluid. The patient's clinical symptoms and imaging featu...
Primary malignant pericardial mesothelioma (PMPM) is an extremely rare and lethal cardiac tumor. This article presents a 62-year-old man with recurrent pericardial fluid. The patient's clinical symptoms and imaging features were nonspecific. Initial diagnosis was constrictive pericarditis. After admission, the patient's symptoms worsened, and echocardiography indicated increased pericardial effusion. To diagnose and improve the patient's symptoms, pericardiotomy was performed; however, the procedure was unsuccessful because the pericardium was densely adherent to the myocardium. Histopathological examination, including immunohistochemical staining of the pericardial specimen revealed malignant mesothelioma. We recommended adjuvant therapy for the patient with cis-platinum and pemetrexed; however, the patient and his family refused treatment. The patient was discharged 11 days after surgery. The patient survived for more than 15 months with surgical treatment. In this report, the patient's symptoms improved, and the patient survived beyond the median survival after surgical treatment. Conclusion: The definitive diagnosis of PMPM mostly has been obtained from specimens obtained by surgery. Surgery is an effective treatment method because it prevents cardiac tamponade and can improve symptoms or prognosis, but complete resection is impossible.
Computed Tomography for Detecting Patent Foramen Ovale: A Meta-Analysis.
Lou J, Bao Y, Lv T … +1 more , Yang Y
Heart Surg Forum · 2022 Dec · PMID 36602503 · Publisher ↗
OBJECTIVE: Patent foramen ovale (PFO) has been regarded as a potential source of cryptogenic stroke, which was conventionally detected by transesophageal echocardiography. Cardiac computed tomography (CCT) is a promising...
OBJECTIVE: Patent foramen ovale (PFO) has been regarded as a potential source of cryptogenic stroke, which was conventionally detected by transesophageal echocardiography. Cardiac computed tomography (CCT) is a promising, noninvasive test for detection of PFO. We sought to conduct a meta-analysis to evaluate the diagnostic performance of CCT in detecting PFO. METHODS: PubMed, ISI Web of Knowledge, Embase, Cochrane Library, and Wanfang from inception to June 2020 were searched for relevant studies comparing CCT and transesophageal echocardiography as the reference standard in detecting PFO. A bivariate model was used to pool sensitivity and specificity and to construct summary receiver operating characteristic (SROC) curves. RESULTS: A total of seven studies with 483 patients were included in this meta-analysis. For the diagnosis of PFO, CCT had a mean sensitivity and specificity of 0.70 [95% CI:0.58, 0.79] and 0.97 [95% CI: 0.95, 0.99]. The SROC analysis showed an area under the curve of 0.97. CONCLUSION: CCT shows good diagnostic accuracy in detecting PFO with relatively high sensitivity and specificity. CCT could be considered a noninvasive alternative to transesophageal echocardiography for detecting PFO.
Right Coronary-Left Ventricular Fistula and Its Course: A Case Report.
Miao S, Zhao H, Wu S … +1 more , Ma L
Heart Surg Forum · 2022 Dec · PMID 36602502 · Publisher ↗
BACKGROUND: Coronary fistula is a relatively rare cardiac disease. The incidence of coronary fistula flowing into the right heart structure is much higher than in inflow into the left heart structures. Opportunities for...
BACKGROUND: Coronary fistula is a relatively rare cardiac disease. The incidence of coronary fistula flowing into the right heart structure is much higher than in inflow into the left heart structures. Opportunities for surgical intervention and treatment strategies for these patients still need to build more consensus. Case presentation: Here, we report a case of right coronary artery-left ventricular fistula combined with a giant coronary artery aneurysm during the treatment course. CONCLUSION: Because of its rarity as well as its specificity of coronary artery fistula, each case requires an individualized evaluation. More consideration also can be given to the choice of surgical approach.
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