Objective: The aim of the study is to assess the therapeutic effect and applicability of pectoralis major muscle turnover flap reconstruction for treatment of deep sternal wound infection after cardiac surgery in infants and children. Methods: From march 2013 to october 2021, 23 patients with deep sternal wound infection after cardiac surgery underwent pectoralis major muscle turnover flap reconstruction.The data and outcomes of the patients were retrospectively analyzed. Results: 20 patients were treated with unilateral pectoralis major muscle turnover flap reconstruction,3 patients were treated by bilateral pectoralis major muscle turnover flap. All of the sternal wounds healed successfully. All patients survived and were discharged without evidence of infection. In a follow-up period, ranging from 15 to 83 months (mean 32.6 months), all patients demonstrated normal development with no limitations to limb movements. There were no signs of chronic sternal infection in all of them. Conclusion:Pectoralis major muscle turnover flap reconstruction is a simple,feasible and effective treatment of deep sternal wound infection after cardiac surgery in infants and children,with minimal developmental problems.
Background VIV-TAVR is established and provides good initial clinical and hemodynamic outcomes. Lacking long-term durability data baffle the expand to lower risk patients. For those purposes, the present study adds a hemodynamic 3-years follow-up. Methods A total of 77 patients underwent VIV-TAVR for failing aortic bioprosthesis during a 7-years period. Predominant mode of failure was stenosis in 87.0%. Patients had a mean age of 79.4±5.8 years and a mean logistic EuroSCORE of 30.8±15.7%. The STS-PROM averaged 5.79±2.63%. Clinical results and hemodynamic outcomes are reported for 30-days, 1-, 2- and 3-years. Completeness of follow-up was 100% with 44 patients at risk after 3-years. Follow-up ranged up to 7.1 years. Results Majority of the surgical valves were stented (94.8%) with a mean labeled size of 23.1±2.3mm and true-ID of 20.4±2.6mm. A true-ID ≤21mm had 58.4% of the patients. Self-expanding valves were implanted in 68.8% (mean labeled size 24.1±1.8mm) and balloon-expanded in 31.2% (mean size 24.1±1.8mm). No patient died intraoperatively. Hospital mortality was 1.3% and three-years survival 57.1%. All patients experienced an initial significant dPmean-reduction to 16.8±7.1mmHg. After 3-years mean dPmean raised to 26.0±12.2mmHg. This observation was independent from true-ID or type of TAVR-prosthesis. Patients with a true-ID ≤21mm had a higher initial (18.3±5.3mmHg vs. 14.9±7.1mmHg; p=0.005) and dPmean after 1-year (29.2±8.2mmHg vs. 13.0±6.7mmHg; p=0.004). There were no significant differences in survival. Conclusions VIV-TAVR is safe and effective in the early period. In surgical valves with a true-ID≤21mm inferior hemodynamic and survival outcomes must be expected. Nonetheless, also patients with larger true-ID’s showed steadily increasing transvalvular gradients. This raises concern about durability.
Objective: To evaluate the perioperative clinical efficacy of preoperative human fibrinogen treatment in patients with acute Stanford type A aortic dissection (ATAAD). Methods: Data of 159 patients with ATAAD who underwent emergency surgical treatment in our hospital from January 2019 to December 2020 were retrospectively analyzed. Patients were divided into two groups according to whether human fibrinogen was administered before surgery. The preoperative clinical data, surgical data, postoperative data, complications related to the coagulation function, and mortality of the two groups were compared and analyzed. Results: The in-hospital mortality was similar in the two groups (2.9% versus 9.3%, P = 0.122). However, group A had a significantly shorter operation time (279.24±39.03 versus 298.24±45.90, P=0.008), lower intraoperative blood loss (240.48±96.75 versus 353.70±189.80, P＜0.001), and reduced intraoperative transfusion requirement of red blood cells (2.61±1.18 versus 6.05±1.86, P＜0.001). The postoperative suction drainage within 24 hours in group A was significantly decreased (243.24±201.52 versus 504.22±341.08，P=0.002). The incidence of postoperative acute kidney injury (AKI) in group A was lower than that in group B (3.8% versus 14.8%, P =0.023). Similarly, the incidence of postoperative hepatic insufficiency in group A was lower than that in group B (1.9% versus 9.3%, P =0.045). In group A, the mechanical ventilation time was shorter (47.68±28.61 versus 118.21±173.16, P=0.004) along with reduced ICU stay time (4.06±1.18 versus 8.09±9.42, P=0.003), and postoperative hospitalization days (19.20±14.60 versus 23.50±7.56, P=0.004). Conclusion: Preoperative administration of human fibrinogen in patients undergoing ATAAD surgery can effectively reduce the intraoperative blood loss, blood transfusion amount, shorten the operation time, reduce postoperative complications, and improve the early prognosis of patients, in addition to being highly safe.
George and colleagues report their experience with a non-transplant left ventricular assist device program (1). This manuscript spans a decade’s experience with LVADs and clearly demonstrates that LVAD therapy is possible in centers without a heart transplant program. 100 LVADs were placed during this period. The positive findings from this report include that as volume increased, the complications of right heart dysfunction and bleeding decreased. Noteworthy is that 85 of the 100 patients were implanted with a fully magnetically levitated ventricular assist device. Given the superior performance of a fully magnetically levitated device to a rotary pump (2) these findings are relevant for all contemporary centers with LVAD programs.The authors importantly sought the resources of a transplant center to ensure that patients who were offered LVAD in their non-transplant center were indeed not candidates for cardiac transplantation. In addition to this fundamental necessity, three features are necessary for a successful non-transplant LVAD program. Firstly, the institution must offer robust infrastructure and support. Secondly there must be a strong surgeon-leader dedicated to overseeing the program. Lastly, cardiologists who are dedicated to heart failure are essential to guide patients to this therapy.The extension of LVAD therapy to patients in non-transplant centers is essential for durable mechanical circulatory support to remain as a vital part of advanced therapies for heart failure. VADs will continue to play an important role in the management of end-stage heart failure for patients who are not eligible for cardiac transplantation. The 2020 Society of Thoracic Surgeons INTERMACs report now offers patients a 5-year survival of 45%(3). The survival of patients with LVADs continues to increase. The data in this current report offer a new perspective and increased access to LVAD therapy for patients with end stage heart failure.ReferencesGeorge TJ, Aldrich A, Smith III RL, et al. Development of a Non-Transplant Left Ventricular Assist Device Program. J Card SurgMehra MR, Uriel Y, Naka Y, et al. A Fully Magnetically Levitated Left Ventricular Assist Device – Final report. N Engl J Med 2019:380:1618-27.Molina EJ, Shah P, Kierman MS, et al. The Society of Thoracic Surgeons Intermacs 202 Annual Report. Ann Thorac Surg 2021;111:778-92.
Understanding the aortic annulus is important for obtaining reproducible and durable aortic valve repair and allowing advances for TAVR treatment of aortic regurgitation. Significant limitations exist when using echocardiography and CT-based imaging with feature tracking at the aortic annulus. Cardiac Magnetic Resonance is used to obtain Regional Longitudinal Strain (RLS) and can be modified to obtain circumferential annular strain at the fibrous and muscular portions of the aortic valve annulus. Holst and colleagues use a novel method to characterize and prove that adverse annular deformation occurs at the muscular portion of the aortic valve annulus in patients with aortic regurgitation. The direction of muscular annular deformation in patients with aortic regurgitation is opposite to the direction of muscular annular deformation in patients with normal aortic valves.
TITLE: Letter to the Editor: The choice of palliative arterial switch operation as an alternative for selected cases in a single center: Experience and midterm resultsARTICLE TYPE: letter to the editorCORRESPONDENCE: 1 . Arun KumarContact: +92 331 3856579 Email: [email protected]: Ghulam Muhammad Mahar Medical College, SukkurAddress: Flat No 108 Columbus Tower Teen Talwar Karachi
Pulmonary artery pseudoaneurysms are a rare but potentially lethal diagnosis. They can be further categorized by etiology or location and are typically successfully treated with endovascular therapies. However, they occasionally require operative intervention. Here, we present a case of a patient who presented with a central pulmonary artery pseudoaneurysm on CT scan with unclear etiology that was initially treated with conservative management. However, this was noted to have rapid enlargement on interval imaging necessitating urgent surgical intervention. The patient underwent a median sternotomy, anterior pulmonary artery arteriotomy for exposure, exclusion of the posterior artery pseudoaneurysm with a bovine pericardial patch, and closure of the anterior arteriotomy with a bovine pericardial patch. The patient did well and was discharged on postoperative day eleven with repeat imaging showing resolution.
Aortic valve regurgitation in patients undergoing LVAD implantation is a significant complication which occurs in up to 10% of patients in the INTERMACS database. Patients who have aortic valve regurgitation at the time of implant have been handled by several methods, including aortic valve leaflets approximation, to aortic valve replacement or even valve closure. We report a case where we used HAART Ring to repair a regurgitant aortic valve during LAVD implant for destination therapy.
Background. We have observed reopening of the occluded “no-touch” saphenous vein (NT SV) composite grafts on follow-up angiograms in patients who underwent coronary artery bypass graftings (CABG). Methods. Between 2008 and 2018, 1283 patients received NT SV conduits without or with surrounding pedicle tissue as composite grafts based on the in situ left internal thoracic artery (ITA) for CABG and underwent early postoperative angiographies. Among the 1283 patients, 53 patients showed 55 occluded SV conduit anastomoses, and 46 patients who had 48 occluded SV anastomoses were re-evaluated by 1-year postoperative angiographies. Results. Early postoperative angiographies in 1283 patients demonstrated overall occlusion rates of 1.2% (56/4518); occlusion rates of the ITA and SV were 0.08% (1/1259) and 1.7% (55/3260), respectively. One-year angiograms demonstrated that 14 occluded SV anastomoses (29.2% [14/48 occluded SV]) of 14 patients became patent. Reopening of occluded SV conduits occurred more frequently in NT SV with pedicle tissue than in NT SV without pedicle tissue (45.0% [9/20] versus 17.9% [5/28]; P=0.057). When we examined the preoperative and 1-year postoperative angiograms, reopening of the occluded SV conduits was not related with progression (P=0.258) or preoperative reversibility score (P=0.115) of native target coronary artery disease. Conclusions. More than a quarter of the occluded SV composite grafts on early postoperative angiograms were patent in the 1-year angiograms. The reopening rates were higher in patients who had received NT SV conduits with pedicle tissue than those who had received NT SV conduits without pedicle tissue.
Systemic right ventricular failure after physiologic repair for dextro-transposition of the great arteries can be managed with durable mechanical circulatory support; however, the right ventricular morphology, such as intervening papillary muscles, presents challenges to inflow cannula positioning. Papillary muscle repositioning is an innovative technique to circumvent the obstructive anatomy.
Background and aim: Ischemic heart disease is the leading cause of death around the world. Coronary artery bypass grafting offers efficient surgical revascularization for ischemic disease. Both on- or off-pump coronary artery bypass methods provide promising results to octogenarians, once complete vascularization is achieved. However, off-pump bypass requires a certain level of experience to achieve sufficient results. We have applied an off-pump coronary artery bypass-first strategy to all generations since 2008. This study investigated early and long-term results of surgical revascularization for octogenarians by a team with an off-pump-first strategy. Methods: All cases of isolated coronary artery bypass grafting performed since 2008 were identified and divided into a young group (age <80 years) and an old group (age >=80 years). Peri-operative results were investigated retrospectively in both groups and long-term results for the old group were assessed. Results: Among the 707 patients, 97% underwent off-pump bypass, and 94 cases were classified to the old group. Distal anastomoses and ventilator time were identical between groups (young vs. old: 3.3 vs. 3.2; 3.7 h vs. 3.7 h). In-hospital death rates were 0.5% and 0% in the young and old groups, respectively. With a mean follow-up of 1318 days, actual 1-, 3-, and 5-year survival rates for octogenarians were 92.1%, 81.2% and 68.3%, respectively. Nearly half of the patients reached their nineties, which was close to the life expectancy of the national general octogenarian. Conclusions: An experienced team with an off-pump-first strategy could provide valid therapeutic options for octogenarians.