Management of Small Aortic Root during Aortic Valve Replacement

Background: Concomitant aortic root enlargement (ARE) increases the risk of aortic valve replacement (AVR). The objectives of this study were to identify the patients who needed aortic root enlargement and compare the outcomes and the risk of adding ARE to AVR. Methods: We retrospectively reviewed 62 patients who underwent isolated mechanical aortic valve replacement between 2017 and 2019. We divided the patients into two groups: group A included patients with small aortic root who had AVR with one of the different surgical strategies for small aortic annulus (n= 32) and group B, which included patients with a normal aortic annulus and underwent conventional AVR (n= 30). Group A was further sub-divided based on the surgical strategy into 4 categories; patients who had supra-annular implantation of size 19 mm St. Jude prosthetic valve (n= 11; 34.4%), Nicks procedure (n= 13 40.6%), Manougian procedure (n= 4; 12.5%), Konno procedure (n= 4; 12.5%).  Results: Group A patients were significantly younger (26.16 ± 11.49 vs. 34.63 ± 8.9 years; p< 0.001) and had lower body weight (55.09 ± 21.41 vs. 69.80 ± 19.20; p= 0.01). Group A had significantly smaller valves (p = 0.03), and total cardiopulmonary bypass (148.65 ± 44.09 vs. 97.46 ± 20.90 minutes; p<0.001) and aortic cross-clamp times (118.13 ± 36.70 vs. 78.06 ± 16.01 minutes; p < 0.001) were significantly longer in group A. There was no significant difference in operative complications between groups. Among patients with small aortic root; Konno procedure had the longest bypass time (236.3 ± 19.70 minutes; p<0.001); cross-clamp time (192.5 ± 22.2 minutes; p <0.001); mechanical ventilation (4.75 ± 0.50 hours; p<0.001) and intensive care unit stay (6.50 ± 0.57 days; p <0.001). Patients with supra-annular implantation of the St. Jude valve had a significantly higher postoperative pressure gradient (14.64 ± 6.84 mmHg; p= 0.02). No difference in procedure complications was observed among aortic root enlargement procedures. Conclusion: Patients who had aortic root enlargement procedure were younger, with lower weight and body surface area. Surgical procedures used to manage small aortic root had comparable early results, and no technique was superior to the others

Chest wall reconstruction still has place in Today’s modern practice:" a tertiary center experience"

Background: The key factor following chest wall resection is the preservation of the stability and integrity of the chest wall to support the respiration and protect the underlying organs. The present study aims to evaluate the use of the available grafts and prosthetic materials at our center in chest wall reconstruction with adherence to the proper surgical techniques, good perioperative and postoperative care to obtain good results. Methods: This is a retrospective single center study that concludes all patients underwent chest wall reconstruction for a variety of defects resulting from resection of tumors, trauma due to primarily firearms or motor car accidents, resection of radio necrotic tissues, infection and dehiscence of median sternotomy wounds after cardiac surgery.  Results: Study population consisted of 30 patients between January 2015and may 2018, among them were 20 male (70%) and 10 female patients (30%), with a median age of 43 ± 16.3 years, resection and reconstruction was performed in 23 cases (15 neoplastic,5 infective and  3 firearm cases) while reconstruction alone was performed in 7 (traumatic flail chest)  cases. Eighteen patients, underwent rib resection with an average 4.18 ± 2.2 ribs (range 2-6). Associated lung resection was performed in 5 patients (27.8 %): diaphragmatic resection was done in 2 cases in addition total sternal resection was performed in 5 cases. Most of the patients (96.7%) had primary healing of their wounds. there was one death (3.3%) in the early postoperative period. The average length of hospital stay for all patients was 8.7 days (range: 5–15). Respiratory complications occurred in three cases in the form of atelectasis and pneumonia at the ipsilateral side of reconstruction. Three cases suffered wound seroma which successfully managed by daily dressing and antibiotic coverage. Conclusions: according to our study and the analysis of similar studies, adequate perioperative preparation of patient undergoing chest wall resection and reconstruction with adherence to effective surgical techniques allowed us to use the available materials at our center for chest wall reconstruction with good and effective results without adding burden in terms of cost on the patient

Surgical Apgar Score in thoracic surgery: how to see it coming?

Abstract Risk scores are very crucial for modern surgical practice. In thoracic surgery, it is important to know when a patient might need postoperative intensive care or an early second look for bleeding before it is too late. The Surgical Apgar Score is a simple yet informative tool to help surgeons preemptively prepare and help their patients in a prompt manner

Awake minimally invasive surgery as a game changer in lung cancer

Surgery still offers the best option for patients with early stage non-small cell lung cancer that can tolerate surgery. With the increase in screening programs, more patients are diagnosed at early stages of cancer. Sadly, not all of them are fit for surgery, but with minimally invasive approaches, large number of those patients can be offered surgery and get a better overall survival. Awake non-intubated video assisted thoracic surgery resection is one of the most recent technique that we believe to be a game changer in this spectrum of patients who were previously classified as medically inoperable

Giant intrathoracic ganglioneuroma with scoliosis treated by one-stage posterior resection and scoliosis correction: a case report

Spinal ganglioneuroma occurs mostly in the thoracic spine causing various manifestations including scoliosis that can be misdiagnosed as idiopathic scoliosis. Few reports exist in the literature on the diagnosis and management of scoliosis secondary to huge ganglioneuroma and usually staged treatment is preferred. In this report, we present a 17-year-old female patient presented with back pain, lower limbs numbness, spinal deformity, and shortness of breath. Plain X-rays showed a 50° right thoracic scoliotic curve. MRI and chest CT revealed a huge extra pulmonary mass shifting the mediastinum with intra spinal extension through the left neural foramina compressing the spinal cord. Percutaneous US guided needle biopsy confirmed the diagnosis of ganglioneuroma. One-stage posterior instrumented correction of scoliosis, spinal cord decompression, and excision of the whole mass from the mediastinum and the spine through posterior approach was done for the patient with smooth postoperative recovery. Chest CT scan was done 2 years after surgery and excluded any local recurrence

Benign intrapericardial lipoma

Intrapericardial extracavitary lipomas are very rare. We would like to share our experience with a case of intrapericardial lipoma in a male aged 54 years. His mode of presentation and radiographic investigations are reported. He was successfully managed via a right anterior thoracotomy

Trends in Thoracic Surgery Literature

This lecture by Alan Sihoe of the University of Hong Kong was given during the Fourth Assiut VATS Workshop in Assiut, Egypt, in February 2018. In this lecture, Professor Sihoe gives an overview of trends in thoracic surgery literature and what editors and reviewers are looking for in submitted manuscripts. This lecture focuses primarily on thoracic surgery researchers from developing countries, but it gives tips and tricks for all researchers that range from choosing a journal for your current research to choosing a new topic for your next research plan