Cardiac Rupture Sutureless Repair

We retrospectively observed the long-term outcome of 40 patients with post-infarction cardiac ruptures repaired with a patch-and-glue technique, treated as an emergency between January 1997 and January 2019. In 32 patients, the cause of the rupture was late percutaneous revascularization. In patients with a poor ejection fraction, extracorporeal membrane oxygenation (ECMO) was used to unload the ventricle for a few days. A follow-up was made at 30 days, 6 months and long term with a mean follow-up of 11.5 ± 10.8 years. Kaplan–Meier curves were used to evaluate the long-term survival. The 30-day mortality was 12.5% (5/40 patients), in patients with very low ejection fraction and was not related to the cardiac rupture. There were no postoperative complications except for bleeding (7.5%), due to ECMO haematologic disorders. No bleeding through the rupture site was recorded. Overall mortality was 15% (6/40 patients) at a 6-month control, at late follow-up (11.5 ± 10.8 years) was 80% (32 patients), and the causes of death were not related to the rupture. We can affirm that a patch-and-glue technique is a safe and life-saving operation to treat cardiac ruptures. An early diagnosis and surgical treatment are crucial for a successful outcome

Unexpected limited chronic dissection of the ascending aorta

We report a rare case of a limited chronic dissection of the ascending aorta that was accidentally discovered at operation performed for severe aortic stenosis and moderate to severe dilatation of the ascending aorta. Preoperative investigations such as transoesophageal echocardiography and cardiac catheterization missed the diagnosis of dissection. Intraoperative findings included a 3.5 cm eccentric bulge of the ascending aorta and a 5 mm circular shaped intimal tear comunicating with a limited hematoma or small dissection of the media layer. (The rarety of the report is that the chronic dissection is limited to a small area (approximatively 3.5 × 2.5 cm) of the ascending aorta)

Safety and usefulness of composite grafts for total arterial myocardial revascularization: A prospective randomized evaluation

AbstractObjectives: To evaluate the results of total arterial revascularization with composite grafts compared with the results of conventional coronary surgery, we enrolled 200 consecutive patient undergoing myocardial revascularization. Methods: Patients were randomly assigned to 2 groups of 100 patients each: group 1 underwent total arterial revascularization, and group 2 received left internal thoracic artery on left anterior descending artery grafts plus additional saphenous vein grafts. The groups were comparable in terms of continuous and discrete variables and preoperative risk factors. Results: There were no differences between group 1 and group 2 in terms of the number of grafted vessels (mean, 2.8 vs 2.9, respectively), crossclamping time (mean, 38 ± 7 vs 40 ± 6 min, respectively), intensive care unit stay (mean, 25 ± 8 vs 24 ± 7 hours, respectively), and hospital mortality (1% in both groups) nor were there any differences in postoperative complications. At the mean follow-up of 12 ± 4 months, patients receiving total arterial revascularization (group 1) showed a better outcome in terms of angina recurrence (group 1 vs group 2: 2 vs 13 patients, P =.007), need of percutaneous transluminal coronary angioplasty reintervention (group 1 vs group 2: 0 vs 8 patients, P =.0012), and actuarial freedom from cardiac events (group 1 vs group 2: 96% vs 67%, P =.006). Angiography carried out in 72% in group 1 and in 68% in group 2 demonstrated a patency rate of 99% of saphenous vein grafts in group 1 and 89% of saphenous grafts in group 2. Conclusions: Total myocardial revascularization with composite arterial grafts provided superior clinical results and improved patient outcome, even in the short term to midterm. Arterial conduit-related benefits were clearly evident with respect to recurrence of angina and a higher graft patency rate.J Thorac Cardiovasc Surg 2003;125:826-3