The Heart Surgery Forum

Arterial Cannulation Through Aneurysm and Aortic Anastomosis During Proximal Thoracic Aortic Aneurysm Surgery

Wed, 20 Nov 2024 00:00:00 -0800

Background: Proximal aortic aneurysm surgery involving the aortic root and ascending aorta represents a specific surgical intervention in terms of the number of surgical incisions, arterial cannulation methods as well as anastomosis technique and cerebral protection. This study aims to present a case series of a new surgical technique for proximal aortic aneurysm surgery exclusively through midsternal approach and consisting of arterial cannulation from the aneurysmatic segment and through aortic anastomosis. Methods: This retrospective study included 90 patients who were operated for proximal thoracic aortic aneurysm using a new surgical technique mainly consisting of single standard midsternal approach without extension of the incision, arterial cannulation through the aneurysmatic segment and aortic anastomosis, deep hypothermic circulatory arrest, and open distal anastomosis without cerebral perfusion. Results: Ascending aorta replacement (replacement) and ascending aorta replacement plus aortic root replacement (ARR) was performed in 60 (66.7%) and 30 (33.3%) patients, respectively. Intraoperative courses were uneventful. The mean durations for deep hypothermic circulatory arrest (DHCA), cross-clamp, and cardiopulmonary bypass were 24.9 ± 3.2 min, 169.7 ± 52.8 min, and 235.3 ± 57.6 min, respectively. Most common postoperative complication was atrial fibrillation (18.9%) followed by inotropic need (10%) and wound infection (7.8%). Three patients died (3.3%) during hospitalization. Conclusions: This new method for the treatment of proximal aortic aneurysms offers a viable and safe alternative with only midsternal surgical incision, without damaging any segment of the healthy aortic tree for arterial cannulation, without prolonging the operation time, and avoiding complications related to additional incisions and cannulation of the healthy aortic tree.

Totally Thoracoscopic Treatment of Cardiac Myxoma: Experience from 29 Cases and Review of the Literature

Abudousaimi Aini, Duolikun Mutailifu, Zi-Xiang Yu, Abudunaibi Maimaitiaili — Tue, 19 Nov 2024 00:00:00 -0800

Background: Cardiac myxoma, a rare benign tumor, can cause significant patient morbidity if left untreated. Traditionally, treatment has involved open sternotomy; however, recent advancements now enable minimally invasive resection using totally thoracoscopic techniques. Methods: This retrospective study reviewed 29 cases of totally thoracoscopic resections of cardiac myxomas performed at our department between January 2019 and October 2022. Perioperative data were analyzed, and the surgical outcomes of a single surgeon's clinical experience were evaluated. Results: The study included 20 men and nine women, with a mean age of 49 ± 10.38 years. All surgeries were uneventful, with an average tumor size of 34.46 mm × 25.07 mm. The mean operation time was 230.17 ± 59.67 min, and the average cardiopulmonary bypass time was 93.14 ± 28.15 min. No intraoperative complications or postoperative deaths were reported. Follow-up transthoracic echocardiography at 12 months showed no residual intracardiac tumors or other abnormalities. Conclusion: Totally thoracoscopic resection of cardiac myxomas was demonstrated to be a safe and effective procedure, offering rapid recovery and a low complication rate, aligning with modern trends in minimally invasive cardiac surgery.

Predictive Role of Preoperative Controlled Nutritional Status Score on Prolonged Mechanical Ventilation after Heart Valve Surgery

Sun, 17 Nov 2024 00:00:00 -0800

Background: Postoperative prolonged mechanical ventilation (MV) in patients with heart valve disease (HVD) is usually concomitant with poor prognosis. Its relationship with preoperative nutritional status still remains unclear. The present study intends to explore the influence of preoperative controlled nutritional status (CONUT) score on early postoperative outcomes and its predictive role in prolonged MV. Methods: HVD patients receiving cardiac surgeries in our department from January 2022 to December 2023 were retrospectively selected. CONUT score was calculated according to the level of serum albumin, total cholesterol and lymphocyte counts. When the CONUT score was greater than or equal to 3, patients were included in high CONUT group, and the other patients were included in low CONUT score group. Propensity score matching (PSM) was used to adjust baseline characteristics. Results: A total of 411 patients were included, of which 129 patients had the preoperative CONUT score greater than or equal to 3 points, accounting for 31.4%. After adjustment at a ratio of 1:2, 103 patients were included in high CONUT group while 206 patients were included in low CONUT group. The incidence of postoperative ventilator associated pneumonia (VAP) in high CONUT group was significantly higher than that in low CONUT group (p = 0.039). Length of ICU stay showed up a significant extension in high CONUT group compared with low CONUT group (p = 0.041). Significantly prolonged MV time could be observed in high CONUT group compared with low CONUT group (p = 0.022). The proportion of patients receiving MV over 48 h and 72 h in high CONUT group significantly increased (p = 0.020 and 0.009 respectively) except for MV over 24 h. MV time of all patients was found to be significantly correlated with CONUT score (r = 0.186, p = 0.001). The area under the curve (AUC) for CONUT predicting MV >48 h was 0.625 (p = 0.008), with sensitivity of 0.419 and specificity of 0.808. The AUC for CONUT predicting MV >72 h was 0.691 (p = 0.003), with sensitivity of 0.545 and specificity of 0.801. Conclusions: Preoperative CONUT score had an accurate predictive role of postoperative prolonged MV and early poor prognosis in HVD patients, which deserves much attention to improve clinical outcomes.

Effects of Preoperative Nutritional Conditions on Postoperative Recovery in Neonates with Congenital Heart Disease

Luo-Cheng Wu, Yi-Nan Liu, Ya-Ting Zeng, Qi-Liang Zhang — Thu, 14 Nov 2024 00:00:00 -0800

Objective: The effects of preoperative nutritional conditions on postoperative recovery in neonates with congenital heart disease (CHD) were evaluated in this study. Methods: A retrospective analysis of data from neonates with CHD who underwent surgery at our hospital from January 2020 to December 2022 was conducted. The relationships between preoperative nutritional conditions and neonatal postoperative recovery were analyzed. Results: Eighty neonates were included in this study. The average gestational age was 38.4 (37, 39.2) weeks, the average birth weight was 3.1 (2.7, 3.4) kg, the average age at surgery was 23 (21, 26) days, and the average preoperative weight was 3.5 (3.0, 3.9) kg. The postoperative mechanical ventilation duration, length of intensive care unit stay, and length of hospital stay of preterm neonates were much longer than those of full-term neonates (p < 0.05). In addition, these values were notably greater for neonates with birth weights ≤3 kg than for neonates with birth weights >3 kg (p < 0.05). The correlation analysis suggested that gestational age, birth weight, preoperative weight-for-age z-score (WAZ) and preoperative height-for-age z-score (HAZ) were negatively correlated with postoperative mechanical ventilation duration, length of intensive care unit stay, and length of hospital stay. Conclusions: Preterm birth and low birth weight significantly prolong the duration of mechanical ventilation and postoperative intensive care unit and hospital length of stay. More attention should be given to nutritional management during the perioperative period for premature or low-birth-weight neonates with CHD. For neonates with CHD requiring surgery, the time available for nutritional support before surgery is very limited; thus, more attention and guidance are needed for prenatal nutritional strategies.

Relative Factor Analysis of Postoperative Complications in Infants Below 1 Year Undergoing Repair of Ventricular Septal Defect Combined with Other Procedures through a Right Axillary Incision

Lai Li, Tianhao Yan, Yijia Liu, Yongchao Xu, Yang Yu, Aijun Liu, Junwu Su — Thu, 14 Nov 2024 00:00:00 -0800

Background: Compared to the traditional surgical repair of isolated ventricular septal defects, the proportion of complex congenital heart diseases has been increasing due to advancements in diagnostic capabilities and surgical techniques. Concomitant surgeries to correct multiple congenital heart diseases have become the preferred choice. Therefore, the evaluation of the safety of the combined correction of ventricular septal defects with other cardiac anomalies in young children through a right axillary incision and the analysis of related factors of perioperative complications needs to be investigated. Methods: A retrospective study was conducted on a single-center patient sample from January 2018 to December 2022 to compare outcomes between infants undergoing isolated ventricular septal defect (VSD) repair via a right axillary thoracotomy (control group) and those undergoing VSD repair combined with other cardiac procedures (experimental group). Results: A total of 397 eligible infants were included. After baseline data were matched using propensity score matching, the experimental group (n = 181) and the control group (n = 107) showed no significant differences in intraoperative blood loss, postoperative total drainage, length of hospital stay, duration of ICU monitoring, Vasoactive-Inotropic Score (VIS), pre-discharge left ventricular ejection fraction, fractional shortening (FS), postoperative severe pulmonary infection, reoperation, mortality, postoperative atrioventricular block, chylothorax, cardiac arrest, pericardial effusion, pneumothorax, pulmonary atelectasis, tricuspid regurgitation, myocardial injury, abdominal effusion, and metabolic acidosis. However, the control group had shorter surgical time [28.00 (90.00, 196.00) vs. 140.00 (95.00, 658.00) min, p < 0.05], shorter cardiopulmonary bypass time [58.00 (24.00, 114.00) vs. 66.00 (33.00, 422.00) min, p < 0.05], shorter aortic cross-clamp time [32.00 (17.00, 62.00) vs. 37.00 (15.00, 142.00) min, p < 0.05], and shorter postoperative mechanical ventilation time [22.00 (0, 99.00) vs. 23.00 (3.00, 193.00) h, p < 0.05]. The rate of abdominal effusion was lower in the experimental group than in the control group (p = 0.044). In the analysis of postoperative complication-related factors, the preoperative grade of tricuspid regurgitation, postoperative mechanical ventilation time, and VIS were positively correlated with abdominal effusion and satisfied the variable (p < 0.05) in each of three established models. In the single-factor analysis, both VIS and preoperative lymphocyte count were (p < 0.1) related to pericardial effusion; however, in the multi-factor analysis, only VIS met the threshold (p < 0.05). Gender, height, and VIS were each associated with pleural effusion (p < 0.05). Conclusion: The combination of ventricular septal defect repair with other cardiac procedures via a right axillary thoracotomy did not significantly differ from isolated VSD repair in terms of postoperative complications, monitoring, and length of hospital stay. However, increased surgical complexity was associated with longer surgical and mechanical ventilation times. Factors such as tricuspid regurgitation severity, duration of postoperative mechanical ventilation, and VIS were identified as relative factors for postoperative effusion. Additionally, the risk of postoperative pericardial effusion increased with higher VIS, while gender, height, and VIS were identified as relative factors for postoperative chylothorax.

Pericardial Tamponade Two Years after Central Venous Catheter Implantation in a Patient with Breast Cancer: A Case Report

Tingqian Cao, Yahui Liu, Yuqiang Wang, Miao Chen, Yingqiang Guo — Thu, 14 Nov 2024 00:00:00 -0800

We report a rare and diagnostically challenging case of pericardial tamponade in a breast cancer patient, treated two years earlier. Echocardiogram and an enhanced computed tomography (CT) scan revealed a large mass in the right pericardium with indistinct borders. A positron emission tomography-computed tomography (PET-CT) scan showed no uptake of fluorine-18 fluorodeoxyglucose (18F-GDP) by the mass. Cardiac magnetic resonance imaging (MRI) with late gadolinium enhancement confirmed no signal enhancement within the mass and a clear border, decisively ruling out malignancy. This case highlights the importance of late gadolinium enhancement in this diagnostically challenging case and explores the pericardial tamponade development mechanism.

Marfan's Syndrome with Acute Inferior Wall ST-segment Elevation Myocardial Infarction in A Combined Family of 13 Cases

Zhizhou Song, Zhenhua Cai, Zejun Meng, Youdong Yang, Qi Wu — Sun, 10 Nov 2024 00:00:00 -0800

Marfan's syndrome (MFS) is a rare autosomal dominant connective tissue disorder, often associated with genetic mutations and most patients have a family history of the disease. Its clinical manifestations are mainly skeletal, ocular and cardiovascular pathologies. We report a case of a 34-year-old male diagnosed with Marfan's syndrome at the age of 22 and presenting with ocular symptoms. Following an episode of sudden chest pain, he was admitted to the hospital with an acute inferior wall ST-segment elevation myocardial infarction, and was diagnosed with a mid-right coronary artery occlusion by coronary angiography. He underwent coronary artery balloon dilatation to restore grade 3 flow, and a stent was implantated 4 months later. In a subsequent epidemiologic survey of 26 family members from 4 generations, 13 members were diagnosed with Marfan's syndrome, all of them presented with ocular signs. After more than 3 years of follow-up of the entire family, there is currently no one with coarctation of the aorta and no sudden death. Since some patients with Marfan's syndrome can present with acute chest pain complicated by aortic coarctation, if the coarctation involves the aortic root it can lead to severe stenosis or occlusion of the coronary arteries, resulting in electrocardiograms showing typical changes for a ST-segment elevation myocardial infarction. Considering the complexity and life-threatening nature of Marfan's syndrome, it is important consider the various etiologies of chest pain in patients with Marfan's syndrome.