Surgical cure of the Wolff-Parkinson-White syndrome a comparison of two techniques

Curative arrhythmia surgery for patients with symptomatic Wolff-Parkinson-White syndrome (WPW) was first performed in South Africa in November 1987. Pre-operatively all patients were symptomatic despite medical therapy, and 32% were assessed as being at risk for sudden death. The first 9 patients (November 1987 to December 1989) underwent either epicardial or localised endocardial surgical dissections, and a cure was obtained in 66%. Aberrant atrioventricular conduction recurred in 2 patients, 30 atrioventricular heart block occurred in 2 patients, and there was 1 postoperative death in a patient who had undergone simultaneous coronary artery bypass grafting. In contrast, a standardised endocardial technique was used in the subsequent 10 patients. Surgical cure was obtained in all 10 patients (P < 0,01). However, 1 patient required reoperation 24 hours after the first procedure because of early postoperative recurrence due to initial incorrect pathway localisation. This was successful. There were no deaths, and no patient developed atrioventricular heart block. In view of the excellent surgical results, arrhythmia surgery should be considered in select WPW patients who either have refractory symptoms or are at risk for sudden death. Furthermore, this reliable surgical technique provides an essential back-up should alternative interventionalprocedures such as percutaneous radiofrequency ablation fail

Surgery for the Wolff-Parkinson-White syndrome - the Groote Schuur Hospital experience

Surgical division of accessory atrioventricular (AV) connections has been performetl on 9 patients with the WolffParkinson- White (WPW) syndrome at Groote Schuur Hospital. All patients had symptomatic paroxysmal tachycardia. The indication for surgery in 5 patients was poor control on antiarrhythmic drugs. Surgery was performed on a 15-year-old boy to prevent lifelong dependence on drugs, although his atrial fibrillation (ventricular rate> 300/min) was controllable with sotalol 1 280 mg daily. The remaining 3 patients required cilrdiac surgery for other indications and therefore their accessory pathways (APs) were divided concurrently. The AP was localised by pre-operative endocardial mapping and intra-operative epicardial mapping. There were 4 posteroseptal, 3 left free-wall and 2 right free-wall pathways. An endocardial approach was used to divide the pathways. All 5 free-wall APs were successfully divided without complications or recurrence. However, 1 patient with paroxysmal atrial fibrillation and severe unstable angina·due to coronary artery disease died unexpectedly 10 days after 4-vessel coronary bypass grafting and division of a posteroseptal AP. Postoperative complications occurred in a further 2 patients with posteroseptal APs. One patient developed complete heart block and is now asymptomatic with a DDD pacemaker, while the other had recurrence of retrograde bypass conduction postoperatively, but is now successfully controlled on sotalol. Therefore 7 of the 8 survivors are free of recurrence of tachycardia on no anti-arrhythmic drugs after a mean follow-up of 14,3 months. New insights into the surgical technique, particularly for division of posteroseptal pathways, can be expected to improve the outlook

Traumatic rupture of the descending thoracic aorta

The management of acute traumatic rupture of the descending thoracic aorta at Groote Schuur Hospital between January 1984 and December 1989 is reviewed. Aortic rupture was diagnosed angiographically in 18 of 150 patients (12%), who underwent aortography because this injury was suspected. However. 3 of these patients had false-positive angiograms. The diagnosis was initially missed in 31% of patients, and this contributed to morbidity and mortality. Simple aortic crossclamping (N = 8) was used before September 1988 and 3 patients died - 1 intra-operatively from cardiac arrhythmia and 2 postoperatively, where major peri-operative haemorrhage had occurred. In contrast, partial heparin-less bypass (N = 5) using a centrifugal vortex pump was used after September 1988, and there were no haemorrhagic or paraplegic complications or mortality in this group. This technique is safe and appears to be superior to simple aortic crossclamping in managing this condition

Safety of maintaining elective and emergency surgery during the COVID-19 pandemic with the introduction of a Protected Elective Surgical Unit (PESU): A cross-specialty evaluation of 30-day outcomes in 9,925 patients undergoing surgery in a University Health Board

Background The COVID-19 pandemic has caused unprecedented health care challenges mandating surgical service reconfiguration. Within our hospital, emergency and elective streams were separated and self-contained Protected Elective Surgical Units were developed to mitigate against infection-related morbidity. Aims of this study were to determine the risk of COVID-19 transmission and mortality and whether the development of Protected Elective Surgical Units can result in significant reduction in risk. Methods A retrospective observational study of consecutive patients from 18 specialties undergoing elective or emergency surgery under general, spinal, or epidural anaesthetic over a 12-month study period was undertaken. Primary outcome measures were 30-day postoperative COVID-19 transmission rate and mortality. Secondary adjusted analyses were performed to ascertain hospital and Protected Elective Surgical Unit transmission rates. Results Between 15 March 2020 and 14 March 2021, 9,925 patients underwent surgery: 6,464 (65.1%) elective, 5,116 (51.5%) female, and median age 57 (39–70). A total of 69.5% of all procedures were performed in Protected Elective Surgical Units. Overall, 30-day postoperative COVID-19 transmission was 2.8% (3.4% emergency vs 1.2% elective P  70, male sex, American Society of Anesthesiologists grade > 2, and emergency surgery were all independently associated with mortality. Conclusion This study has demonstrated that Protected Elective Surgical Units can facilitate high-volume elective surgical services throughout peaks of the COVID-19 pandemic while minimising viral transmission and mortality. However, mortality risk associated with perioperative COVID-19 infection remains high

Thoracofemoral Bypass Using Spliced Femoral Vein with Removal of an Infected Axillobifemoral Bypass Graft

AbstractA 63-year-old male underwent emergency repair of a ruptured juxtarenal aortic aneurysm via a transabdominal approach using an aorto-bi-iliac Dacron graft. This became infected. A right axillobifemoral bypass was placed and the infected graft was removed with oversewing of the aorta. The patient was re-admitted 8 months later with an infected axillobifemoral prosthesis. We harvested both femoral veins (FV) and spliced them to perform a left thoracobifemoral bypass with simultaneous explantation of the infected graft. The patient remains well with a patent graft 20 months post-operatively