Epicardial Pacing Wire Migration Into The Thoracic Aorta

none7nononeMalvindi P.G.; Margari V.; Favale A.; Kounakis G.; Visicchio G.; Paparella D.; Carbone C.Malvindi, P. G.; Margari, V.; Favale, A.; Kounakis, G.; Visicchio, G.; Paparella, D.; Carbone, C

Minimally invasive tricuspid valve surgery without caval occlusion: Short and midterm results

Objective: The use of minimally invasive or transcatheter interventions rather than standard full sternotomy operations to treat tricuspid valve (TV) disease is increasing. The debate however is still open regarding venous drainage management during cardiopulmonary bypass (CPB) and wheatear or not superior and inferior vena cava should be occluded during the opening of the right atrium to avoid air entrance in the venous line. The aim of the present study is to report operative outcomes and midterm follow-up results of minimally invasive TV surgery performed without caval occlusion. Methods: A retrospective outcome evaluation from institutional records was performed with prospective data entry. Considered were consecutive patients who underwent right mini-thoracotomy TV surgery isolated or combined with mitral valve surgery during the period from June 2013 to February 2020. A telephone and echocardiographic follow-up was performed. Results: During the study period, 68 consecutive patients underwent minimally invasive TV surgery without occlusion of cava veins. The mean age was 69 ± 14 years and 48 (70%) were female. All operations were performed safely without air-lock during CPB. A perioperative cerebral stroke occurred in one patient. The survival at a 5- and 8-year follow-up was 100% and 79%, respectively. No severe tricuspid regurgitation was evident at echocardiographic follow-up. Conclusion: Our results show that performing tricuspid surgery without caval occlusion is safe. The air was captured by the active vacuum drainage system without causing damage. Midterm follow-up data confirm that a minimally invasive approach does not alter the quality of surgery

Preoperative C-Reactive Protein Predicts Mid-Term Outcome After Cardiac Surgery

Background: C-reactive protein (CRP) is a known risk factor for cardiovascular events in the healthy population and in patients with coronary artery disease. High CRP levels before cardiac surgery are associated with worse short-term outcome, but its role after discharge home remains unknown. The study objective was to evaluate the effect of CRP on short-term and mid-term outcome after cardiac surgery. Methods: From August 2000 to May 2004, values for preoperative CRP were available for 597 unselected patients undergoing cardiac operations. CRP was used to divide this cohort in two groups: a low inflammatory status (LHS) group of 354 patients with CRP of less than 0.5 mg/dL, and a high inflammatory status (HIS) group of 243 patients with a CRP of 0.5 mg/dL or more. Follow-up lasted a maximum of 3 years (median, 1.8 ± 1.5 years) and was 92.6% complete. Results: In-hospital mortality was 8.2% in the HIS group and 3.4% in the LIS group (odds ratio [OR], 2.61; p = 0.02). Incidence of postoperative infections was 16.5% in the HIS group and 5.1% in the LIS group (OR, 3.25; p = 0.0001). Sternal wound infections were also more frequent in the HIS group (10.7% versus 2.8%; OR, 3.43; p = 0.002). During follow-up, the HIS group had worse survival (88.5% ± 2.9% versus 91.9% ± 2.5%; OR, 1.93; p = 0.05) and a higher need of hospitalization for cardiac-related causes (73.6% ± 6% versus 86.5% ± 3.2%; OR, 1.82; p = 0.05). Conclusions: Patients undergoing cardiac surgery with a CRP level of 0.5 mg/dL or more are exposed to a higher risk of in-hospital mortality and postoperative infections. Despite surgical correction of cardiac disease, a high preoperative CRP value is an independent risk factor for mid-term survival and hospitalization for cardiac causes. © 2006 The Society of Thoracic Surgeons

Cardiac Troponin I release following coronary artery bypass surgery. Effects on operative and mid-term survival

Objective: Myocardial infarction (MI) associated with coronary artery bypass grafting (CABG) operations represents a serious and relatively frequent peri-operative complication. Markers of myocardial necrosis are usually found elevated in patients undergoing coronary bypass operation with cardiac arrest. Cardiac troponin I (cTnI) is the preferred marker to detect acute myocardial ischemia. Its ability to predict short and, particularly, midterm outcome following coronary bypass operations is uncertain. The aim of the presented study is to assess the role of postoperative cTnI in predicting in-hospital and mid-term outcome in non-selected patients undergoing CABG and to suggest a critical use of cTnI to improve post-operative care of patients with elevated troponin release. Methods: Between May 2000 and February 2003, 230 unselected patients undergoing surgical revascularization had cTnI measured preoperatively and 11 times postoperatively. Patients with unstable angina and recent MI (<7 days) were included in the study. Patients undergoing aortic dissection surgery and those undergoing heart valve procedures with associated CABG as well as patients transferred on emergency in the operative room following complicated percutaneous coronary intervention were excluded. A receiver operating characteristics (ROC) curve was constructed using cTnI postoperative peak values to assess prognostic specificity and sensitivity of the test. 13 ng/ml is the cut-off value used to assess the prognostic significance of peak cTnI postoperative release for short and mid-term outcome for mortality and hospitalization for cardiac causes. Mean and maximal follow-up were 22.6\ub110.7 and 48.3 months, completeness 90%. Results: 146 patients (63.5%) had postoperative cTnI peak values <13 ng/ml (mean peak value 6.6\ub13.1 ng/ml), 84 patients (36.5%) had postoperative cTnI peak values >13 ng/ml (mean peak value 45.5\ub159.9 ng/ml). Patients with peak cTnI >13 ng/ml were older, had lower body mass index and had higher preoperative cTnI values. They required longer cross-clamp time and CPB time. Post-operative results are shown. Hospital death was significantly higher in cTnI >13 ng/ml group (9.5% vs. 0.7%, P = 0.0009). = 0.0009). Multivariate analysis showed that cTnI >13 ng/ml was the only independent predictor of hospital death (OR 10.33, P = 0.04) and hospital death for = 0.04) and hospital death for cardiac causes. Two years follow-up demonstrate that cTnI postoperative release had no influence on mid-term mortality and hospitalization for cardiac causes.Conclusions: The presented is the largest study reporting mid-term survival for CABG patients based on postoperative cTnI release. CTnI is a valuable marker for immediate myocardial damage following coronary bypass operations. CTnI postoperative release does not predict mid-term outcome

Minimally invasive tricuspid valve surgery without caval occlusion: Short and midterm results

Objective: The use of minimally invasive or transcatheter interventions rather than standard full sternotomy operations to treat tricuspid valve (TV) disease is increasing. The debate however is still open regarding venous drainage management during cardiopulmonary bypass (CPB) and wheatear or not superior and inferior vena cava should be occluded during the opening of the right atrium to avoid air entrance in the venous line. The aim of the present study is to report operative outcomes and midterm follow-up results of minimally invasive TV surgery performed without caval occlusion. Methods: A retrospective outcome evaluation from institutional records was performed with prospective data entry. Considered were consecutive patients who underwent right mini-thoracotomy TV surgery isolated or combined with mitral valve surgery during the period from June 2013 to February 2020. A telephone and echocardiographic follow-up was performed. Results: During the study period, 68 consecutive patients underwent minimally invasive TV surgery without occlusion of cava veins. The mean age was 69 ± 14 years and 48 (70%) were female. All operations were performed safely without air-lock during CPB. A perioperative cerebral stroke occurred in one patient. The survival at a 5- and 8-year follow-up was 100% and 79%, respectively. No severe tricuspid regurgitation was evident at echocardiographic follow-up. Conclusion: Our results show that performing tricuspid surgery without caval occlusion is safe. The air was captured by the active vacuum drainage system without causing damage. Midterm follow-up data confirm that a minimally invasive approach does not alter the quality of surgery