Biatrial Recurrence of Two Independently Growing Cardiac Myxoma in a Patient with Multiple Tumor Disease

We report the case of a 56-year-old female patient with biatrial recurrence of cardiac myxoma and extensive comorbidities. In the literature, only few cases of biatrial myxoma can be found and they generally describe a single tumor reaching both atria. We found two independently growing cardiac myxomas of both atria

The frozen elephant trunk technique in acute aortic dissection: the ultimate solution? An institutional experience

ObjectiveAcute aortic dissection remains a serious emergency in the field of cardiovascular medicine and a challenge for cardiothoracic surgeons. In the present study, we seek to compare the outcomes of different surgical techniques in the repair of type A acute aortic dissection.MethodsBetween April 2015 and May 2023, 213 patients (82 women, aged: 63.9 ± 13.3 years) with acute aortic dissection (205 type A and 8 non-A-non-B dissections) underwent surgical treatment in our department. A total of 45 patients were treated with the frozen elephant trunk (FET) technique supported by the Thoraflex™ Hybrid prosthesis, 33 received total aortic arch replacement (TAR)—standard or conventional elephant trunk—treatment, and 135 were treated with hemiarch replacement (HR). Aortic arch surgery was performed in most patients under moderate hypothermic (28°C on average) circulatory arrest, with selective antegrade cerebral perfusion through the right axillary artery.ResultsThe rates of early mortality were 17.8% (38 perioperative deaths) in the whole population, 8.9% in the FET group of patients, and 33% and 17% in the TAR and HR group of patients, respectively (P-value 0.025). The rate of spinal cord injury was 2.3% (five patients), and a paresis of recurrent laryngeal occurred in 3.7% of patients (seven patients, four were treated with FET). Permanent neurological dysfunction occurred in 27 patients (12.7%). After a mean follow-up of 3 years, the rate of mid-term mortality of discharged patients was 19.4% (34 deaths: 7 FET, 4 TAR, and 23 HR) and the overall mortality rate was 33.8% [72 deaths: 11 FET (24.4%); 15 TAR (45.4%); 46 HR (34.1%)]. A total of 8 patients (17.8%) in whom FET was applied received additional endovascular treatment in the descending aorta.ConclusionsIn our institutional experience, we found that the frozen elephant trunk technique with a high-end Thoraflex Hybrid prosthesis proved its surgical suitability in the treatment of acute aortic dissection with favorable outcomes. The FET technique and our perioperative management led to comparable neurological outcomes and reduced mortality rates in these emergency cases

Is mitral valve repair superior to replacement for chronic ischemic mitral regurgitation with left ventricular dysfunction?

<p>Abstract</p> <p>Background</p> <p>This study was undertaken to compare mitral valve repair and replacement as treatments for ischemic mitral regurgitation (IMR) with left ventricular dysfunction (LVD). Specifically, we sought to determine whether the choice of mitral valve procedure affected survival, and discover which patients were predicted to benefit from mitral valve repair and which from replacement.</p> <p>Methods</p> <p>A total of 218 consecutive patients underwent either mitral valve repair (MVP, n = 112) or mitral valve replacement (MVR, n = 106). We retrospectively reviewed the clinical material, operation methods, echocardiography check during operation and follow-up. Patients details and follow-up outcomes were compared using multivariate and Kaplan-Meier analyses.</p> <p>Results</p> <p>No statistical difference was found between the two groups in term of intraoperative data. Early mortality was 3.2% (MVP 2.7% and MVR 3.8%). At discharge, Left ventricular end-systolic and end-diastolic diameter and left ventricular ejection fraction (LVEF) were improved more in the MVP group than MVR group (P < 0.05), however, in follow-up no statistically significant difference was observed between the MVR and MVP group (P > 0.05). Follow-up mitral regurgitation grade was significantly improved in the MVR group compared with the MVP group (P < 0.05). The Kaplan-Meier survival estimates at 1, 3, and 5 years were simlar between MVP and MVR group. Logistic regression revealed poor survival was associated with old age(#75), preoperative renal insufficiency and low left ventricular ejection fraction (< 30%).</p> <p>Conclusion</p> <p>Mitral valve repair is the procedure of choice in the majority of patients having surgery for severe ischemic mitral regurgitation with left ventricular dysfunction. Early results of MVP treatment seem to be satisfactory, but several lines of data indicate that mitral valve repair provided less long-term benefit than mitral valve replacement in the LVD patients.</p

Skeletonization of radial and gastroepiploic conduits in coronary artery bypass surgery

The use of a skeletonized internal thoracic artery in coronary artery bypass graft surgery has been shown to confer certain advantages over a traditional pedicled technique, particularly in certain patient groups. Recent reports indicate that radial and gastroepiploic arteries can also be harvested using a skeletonized technique. The aim of this study is to systematically review the available evidence regarding the use of skeletonized radial and gastroepiploic arteries within coronary artery bypass surgery, focusing specifically on it's effect on conduit length and flow, levels of endothelial damage, graft patency and clinical outcome. Four electronic databases were systematically searched for studies reporting the utilisation of the skeletonization technique within coronary revascularisation surgery in humans. Reference lists of all identified studies were checked for any missing publications. There appears to be some evidence that skeletonization may improve angiographic patency, when compared with pedicled vessels in the short to mid-term. We have found no suggestion of increased complication rates or increased operating time. Skeletonization may increase the length of the conduit, and the number of sequential graft sites, but no clear clinical benefits are apparent. Our study suggests that there is not enough high quality or consistent evidence to currently advocate the application of this technique to radial or gastroepiploic conduits ahead of a traditional pedicled technique

SURGICAL SPECIFICS OF OFF-PUMP MYOCARDIAL REVASCULARIZATION BY OPCAB METHOD

OPCAB (Off-pump coronary artery bypass) remains nowadays an alternative method to traditional on-pump technique of the myocardial revascularization especially in high-risk and elderly patients. A successful adoption of this technique depends on a surgeon’s experience, a cooperative team and standardization of all steps in anesthesiological and surgical procedures in perioperative period. This article describes the perioperative policy adopted in our institution and our view on the role and place of OPCAB in the treatment of patients with coronary heart disease

Transvenous pacemaker in a child less than 6 kg

The insertion of transvenous pacemakers in chidren is limitated by the calibre of the upper chest veins and for this reason, many children receive epimyocardial leads. This article reports a small patient who developed complete atrioventricular block after an arterial switch operation for transposition of the great arteries.peer-reviewe