The use of sutureless and rapid-deployment prostheses is generally avoided in patients with BAV due to anatomical concerns and the elevated risk of para-prosthetic leaks. Multiple studies have reported the use of these prostheses in patients with BAV with varying degrees of success. The focus of this review is to consolidate the available evidence on this topic. A scoping review was conducted using a comprehensive search strategy within Medline, Embase, and Cochrane Central Register of Controlled Clinical Trials for relevant articles. All abstracts and full texts were screened by two independent reviewers according to predefined inclusion and exclusion criteria. Of 1052 total citations, 44 underwent full text review and 13 (4 case reports, 6 retrospective analyses, and 3 prospective analyses) were included in the scoping review. Across all 13 studies, a total of 314 patients with BAV were used for data analysis. In sutureless and rapid-deployment prostheses, the mean postoperative aortic valvular gradients were less than 15mmHg in all studies with mean postoperative aortic valvular areas all greater than 1.3cm. There were 186 total complications for an overall rate of 59%. Individual complications included new onset atrial fibrillation (n=65), required pacemaker insertion (n=24), intraprosthetic aortic regurgitation (n=20), new onset atrioventricular block (n=18), and new onset paravalvular leakage (n=10). The use of sutureless and rapid deployment prostheses in patients with BAV showed comparable intraoperative and implantation success rates to patients without BAV. Various techniques have been described to minimize complications in patients with BAV receiving sutureless or rapid-deployment prostheses.
We report a first case with the use of extracorporeal carbon dioxide removal system as a bridge to re-do lung transplant in complete situs inversus patient. A 29-year-old female with Kartagener syndrome and complete situs inversus underwent a double lung transplant for end stage lung disease. Within one year after transplant the patient had primarily hypercapnic respiratory failure with radiographic signs of chronic lung allograft dysfunction. To optimize her nutritional status and muscle strength before re-do lung transplantation, we decided to bridge her with an extracorporeal carbon dioxide removal system due to anatomical difficulty. She was listed and underwent an uneventful re-do double lung transplant with cardiopulmonary support.
Rheumatic mitral valve disease is now rare in high income countries, except for migrant and older residents, it remains an important and ongoing cause of preventable heart disease in Indigenous populations. Despite our major advances in medical technology and understanding, rheumatic fever remains a serious public health problem throughout the world.
Background: Initial clinical evaluation (ICE) is traditionally considered a useful screening tool to identify frail patients during the pre-operative assessment. However, emerging evidence supports the more objective assessment of cardiorespiratory fitness (CRF) via cardiopulmonary exercise testing (CPET) to improve surgical risk stratification. Herein, we compared both subjective and objective assessment approaches to highlight the interpretive idiosyncrasies. Methods: As part of routine pre-operative patient contact, patients scheduled for major surgery were prospectively ‘eyeballed’ (ICE) by two experienced clinicians prior to more detailed history taking that also included American Society of Anaesthesiologists score classification. Each patient was subjectively judged to be either ‘frail’ or ‘not frail’ by ICE and ‘fit’ or ‘unfit’ from thorough review of the medical notes. Subjective data were compared against the more objective validated assessment of post-operative outcomes using established CPET ‘cut-off’ metrics incorporating peak pulmonary oxygen uptake ( V̇O 2PEAK), V̇O 2 at the anaerobic threshold ( V̇O 2-AT) and ventilatory equivalent for carbon dioxide that collectively informed risk stratification. These data were retrospectively extracted from a single-centre prospective National Health Service database. Data were analysed using the Chi-square automatic interaction detection decision tree method. Results: A total of 127 patients examined that comprised 58 % male and 42 % female patients aged 69 ± 10 y with a BMI of 29 ± 7 kg/m 2. Patients were poorly conditioned with a peak pulmonary oxygen uptake almost 20 % lower than that predicted for age, sex-matched healthy controls with 35 % exhibiting a V̇O 2-AT <11 mL/kg/min. Disagreement existed between the subjective assessments of risk with ~34 % of patients classified not frail on ICE were considered unfit by notes review ( P < 0.0001). Furthermore, ~35 % of patients considered not frail on ICE and ~31 % of patients considered fit by notes review exhibited a V̇O 2-AT <11 mL/kg/min and of these, ~28 % and ~19 % were classified as intermediate-to-high risk. Conclusions: These findings highlight the interpretive limitations associated with the subjective assessment of patient frailty with surgical risk classification underestimated in up to a third of patients compared to the validated assessment of CRF. They reinforce the benefits of a more objective and integrated approach offered by CPET that may help improve perioperative risk assessment and better direct critical care provision in patients scheduled for ‘high-stakes’ surgery including open TAAA repair.
Here, we report a case of a dissected thoracoabdominal aortic aneurysm repair after frozen elephant trunk implantation, using aortic balloon occlusion technique to simplify the proximal anastomosis and avoid deep hypothermic circulatory arrest. In addition, detailed CT follow-up pictures showed that false lumen thrombosis is a time-dependent and reversible variable. Repeated measurements with time series analysis should be performed to explore false lumen remodeling.
In total arch replacement, using frozen elephant trunk (FET) or elephant trunk techniques ensures proximalization of the distal anastomosis. However, in some cases, the left subclavian artery (LSCA) is deeply located and difficult to visualize. Therefore, surgeons face technical challenges during the LSCA reconstruction. We report an end-to-side anastomosis technique that enables safer and easier anatomical reconstruction of the LSCA.
Abstract: Background: Fluid overload (FO) and acute kidney injury (AKI) after CABG surgery are due to multiple perioperative etiologies associated with high failure to rescue rates (FTR) and associated with poor outcomes 1-,3. Diuretics, fluid restriction, ultrafiltration (UF) and renal replacement therapies are the treatment modalities implemented as monotherapy or in combination to address this severe complication. There is limited data on the use of simplified UF therapy as a fluid management strategy in post-operative cardiac surgery patients. Methods: A retrospective review of our post operative isolated CABG patients was done from Jan 1 st, 2020 to July 31 st, 2021. Those subjected to a simplified UF protocol incorporating Goal Directed Therapy (GDT) to treat fluid overload and/or acute kidney injury were evaluated for 30-day survival and readmission rates. Results: A total of 254 isolated CABG procedures were performed during this period. Ultrafiltration was used in 17 (6.7%) patients. The 30-day mortality for the entire CABG cohort was 5/254 (2.0%) patients and in the UF group 0/17 (0%). The mean age of UF therapy patients was 65.8 years (Range 41-89). The mean Society of Thoracic Surgeons STS mortality score of UF patients was 5.7% (Range 0.6-50.0). The 30-day survival for the 17 patients placed on UF therapy was 100% and their readmission rate was 2/17 (11.7%). Conclusions: The use of ultrafiltration in this patient population with relatively high STS scores provided a safe and effective modality to manage fluid balance but further studies are needed.
Introduction Extracorporeal membrane oxygenation (ECMO) is implemented as a rescue therapy in COVID-19 related acute distress respiratory syndrome (ARDS) and refractory hypoxemia. Google trends (GT) is an ongoing-developing web-kit providing feedback on specific population’s interests. This study uses GT to analyze the United States (US) general population interest in ECMO as COVD-19/ARDS salvage therapy. Methods GT was used to access data searched for the term ECMO and COVID-19. The gathered information included data from March 2020 through July 2021 within US territories. Search frequency, time intervals, sub-regions, frequent topics of interest, and related searches were analyzed. Data was reported as search frequency on means, and a value of 100 represented overall peak popularity. Results The number of Google searches related to the terms ECMO and COVID-19 has surged and sustained interest over time ever since the initial reports of COVID-19 in the US, from an initial mean of 34% in March 2020 to a 100% interest by April 2020, resulting in an up-to-date overall average of 40% interest. Over time West Virginia, Gainesville, and Houston, lead the frequency of searches in sub-region, metro and city areas, respectively. Top search terms by frequency include: ECMO machine, COVID ECMO, what is ECMO, ECMO treatment and VV ECMO. Parallel to this, the related rising terms are: COVID ECMO, ECMO machine COVID, ECMO for COVID, ECMO machine coronavirus, and ECMO vs ventilator. Seemingly, medical-relevant websites fail to adequately address these for patient therapeutic education (PTE) purposes. Conclusions GT complements the understanding of interest in ECMO for COVID-19. When properly interpreted, the use of these trends can potentially improve on PTE and therapy awareness via specific medical relevant websites.
Background and aim of the study Objective of this analysis was to use coronary computed tomography in patients with normal tricuspid aortic valves to perform detailed aortic root and aortic valve geometric analysis with focus on asymmetry of the three leaflets. Materials and methods We analyzed aortic valves in 70 anonymized coronary computed tomography angiograms. Mean patient age was 53 ± 11 years. All aortic valves were tricuspid, without calcifications and aortic roots were of normal dimensions. Asymmetry of the three leaflets in individual patients was assessed by calculating absolute and relative differences between the largest and the smallest of the three leaflets. Results Some degree of asymmetry was present in all analyzed valves. Absolute and relative differences for free margin length were 3.2 ± 1.4 mm and 9.3 ± 3.8%, respectively. The largest relative difference was noted in coaptation area (36.5 ± 16.5%) and the smallest in leaflet effective height (6.1 ± 4.8%). Using predefined cut-off criteria for absolute differences in leaflet dimensions, 86% of the valves were classified as asymmetric. Conclusions Equal free margin length of the three leaflets is not needed for normal tricuspid aortic valve function. Aligning the leaflet free margin length in standardized aortic valve repair may not be necessary in tricuspid aortic valve repair, whereas equalization of effective leaflet heights is.
anterior mini‐thoracotomy in multivessel coronary revascularization by Cyn I read with interest the article, routine minimally invasive approach via left ak and colleagues1. The main problem of mini anterior thoracotomy coronary revascularization is the limited or even bad exposure to the right coronary and posterior obtuse marginal branches which may affect the quality of the distal anastomosis. This is the most important technical point of a successful revascularization.
Key Points · Perventricular device closure of peri-membranous ventricular septal defects is safe and effective when compared to conventional surgery and transcatheter device closure. · Intraprocedural transesophageal echocardiography can effectively guide perventricular device closure of peri-membranous ventricular septal defects and improve safety and success rate. · Hybrid approach improves the outcomes in select patients with congenital heart diseases and complex anatomical defects.
Objective: The traditional outcomes of the Fontan Operation (FO) in Endocardial Cushion Defect (ECD) patients have been suboptimal. Previous studies have been limited by the smaller number of ECD patients, longer study period with an era effect and do not directly compare short-term outcomes of FO in ECD patients with non-ECD patients. Our study aims to address these shortcomings. Methods: A retrospective analysis of the Kids Inpatient Database (2009, 2012, and 2016) for the FO was done. The groups were divided into those who underwent FO with ECD as compared to non-ECD diagnosis. The data was abstracted for demographics, clinical characteristics, and operative outcomes. Standard statistical tests were used. Results: 3380 patients underwent the FO of which 360 patients (11%) were FO-ECD. ECD patients were more likely to have Down syndrome, Heterotaxy syndrome, transposition/DORV, and TAPVR as compared to non-ECD patients. FO-ECD had a higher discharge-mortality (2.84% vs. 0.45%, p=0.04). The length of stay (16 vs. 13 days, p=0.05) and total charges incurred ($ 283, 280 vs. 234, 106, p=0.03) for the admission were higher in the FO-ECD as compared to non-ECD patients. In multivariable analysis: ECD diagnosis, cardiac arrest, acute kidney injury, and post-operative hemorrhage were predictors of mortality. Conclusion: Contemporary outcomes for FO are excellent with very low overall operative mortality. However, the outcomes in ECD patients are inferior with higher operative mortality than non-ECD patients. Occurrence of post-operation complications, associated TAPVR and a diagnosis of ECD were predictive of a negative outcome.