RESUMEN
There are insufficient reports on the use of andexanet alfa in cardiac surgery. A 67-year-old man was diagnosed with type A aortic dissection and performed emergent surgery. His medical history included atrial fibrillation treated with Edoxaban. We performed total arch replacement. Despite administration of enough protamine, fresh frozen plasma, and platelet administration, controlling bleeding was difficult. Thus, Andexanet Alfa was initiated after CPB withdrawal. Surgical bleeding was dramatically controlled after its administration. There were no findings suggestive of an embolic event. In conclusion, administration of Andexanet Alfa is safe after cardiopulmonary bypass withdrawal.
Asunto(s)
Disección Aórtica , Implantación de Prótesis Vascular , Inhibidores del Factor Xa , Humanos , Masculino , Anciano , Disección Aórtica/cirugía , Disección Aórtica/diagnóstico por imagen , Inhibidores del Factor Xa/administración & dosificación , Inhibidores del Factor Xa/efectos adversos , Resultado del Tratamiento , Implantación de Prótesis Vascular/efectos adversos , Administración Oral , Proteínas Recombinantes/administración & dosificación , Aneurisma de la Aorta Torácica/cirugía , Aneurisma de la Aorta Torácica/diagnóstico por imagen , Puente Cardiopulmonar , Pérdida de Sangre Quirúrgica/prevención & control , Enfermedad Aguda , Factor Xa , Aneurisma de la Aorta/cirugía , Aneurisma de la Aorta/diagnóstico por imagenRESUMEN
We investigated impact of persistent malperfusion syndrome (MPS) following central repair of acute type A aortic dissection (ATAAD) on outcomes. Thirty patients who underwent central repair for ATAAD with MPS were included. Patients were divided into two groups:23 patients without MPS following central repair (No-MPS group) and 7 with MPS (Persistent-MPS group). The mean age was 66.8±9.6 and 59.4±13.4 years in the No-MPS and Persistent-MPS groups, respectively (P=0.176). Preoperative MPS included the left coronary artery (n=3), brain (n=3), abdomen (n=7), and extremities (n=11) in the No-MPS group. In the Persistent-MPS group, the right coronary (n=1), brain (n=2), abdomen (n=3), and extremities (n=5) were observed. In the No-MPS group, one patient died of extensive cerebral infarction (4.3%). In the Persistent-MPS group, 2 patients died of sepsis and multi-organ failure, respectively (28.6%) (P=0.061). The Persistent-MPS group had more patients requiring hemodialysis than the No-MPS group (P=0.009). Three patients underwent intestinal resection due to persistent MPS (P<0.001). Persistent MPS following central repair for ATAAD significantly contributed to outcomes. J. Med. Invest. 71 : 158-161, February, 2024.
Asunto(s)
Disección Aórtica , Humanos , Disección Aórtica/cirugía , Masculino , Persona de Mediana Edad , Femenino , Anciano , Enfermedad Aguda , Complicaciones Posoperatorias/etiología , Resultado del Tratamiento , Síndrome , Estudios Retrospectivos , Aneurisma de la Aorta/cirugíaRESUMEN
GRAND FIX mesh-type plates and pins (Gunze, Kyoto, Japan) are thin, bioabsorbable fixation devices made of poly-L-lactide (PLLA) composite. These devices are new, and how best to use them in clinical practice remains to be determined. Thus, we describe our approach to rib fixation after thoracotomy in an aortic surgery using GRAND FIX mesh-type plates and pins. The advantage of our approach is that it is easy to perform, but careful attention should be paid to fix the ribs appropriately.
Asunto(s)
Costillas , Toracotomía , Humanos , Costillas/cirugía , Clavos Ortopédicos , Poliésteres , Implantes AbsorbiblesRESUMEN
OBJECTIVES: This study investigated early and late outcomes between ascending aorta/partial arch replacement and total arch replacement with entry resection in DeBakey type I acute aortic dissection (DIAAD) repair. METHODS AND RESULTS: This study included 98 patients who underwent DIAAD repair from January 2005 to December 2020. Seventy-four patients underwent ascending aorta and partial arch replacement with entry resection (Non-TAR group), and 24 underwent total arch replacement with entry resection (TAR group). The mean follow-up period was 4.8 ± 3.2 years. The follow-up rate was 92.3%. The mean age in the Non-TAR and TAR groups was 68.8 ± 10.4 years and 61.6 ± 13.7 years, respectively (P = 0.046). No difference in preoperative shock and malperfusion syndrome was observed between the groups. Hospital death was observed in 5.4% and 12.5% of the Non-TAR and TAR groups, respectively (P = 0.241). Postoperative permanent neurologic deficits and temporary hemodialysis were more frequently seen in the TAR compared to the Non-TAR group (P = 0.03 and 0.003, respectively). The 5-year survival rates were 95.1% ± 3.4% and 89.2% ± 7.2% in the Non-TAR and TAR groups, respectively (Log-rank P = 0.603). Freedom from downstream aorta-related reinterventions at 5 years was 87.8% ± 4.5% and 64.1% ± 11.0% in the Non-TAR and TAR groups, respectively (Log-rank P = 0.007). Three patients in each group underwent thoracic endovascular aortic repair for residual aortic dissection. CONCLUSIONS: Early and late outcomes in the Non-TAR group were satisfactory compared to those in the TAR group. Entry resection with graft replacement remains a standard approach in DIAAD repair.
Asunto(s)
Aneurisma de la Aorta Torácica , Disección Aórtica , Implantación de Prótesis Vascular , Humanos , Persona de Mediana Edad , Anciano , Aorta Torácica/diagnóstico por imagen , Aorta Torácica/cirugía , Aneurisma de la Aorta Torácica/diagnóstico por imagen , Aneurisma de la Aorta Torácica/cirugía , Implantación de Prótesis Vascular/efectos adversos , Implantación de Prótesis Vascular/métodos , Resultado del Tratamiento , Complicaciones Posoperatorias/cirugía , Estudios Retrospectivos , Aorta/cirugía , Disección Aórtica/diagnóstico por imagen , Disección Aórtica/cirugíaRESUMEN
The St. Jude Medical Epic Supra valve is a porcine bioprosthesis designed for complete supraannular implantation. No report has shown the hemodynamic performance and clinical outcomes of aortic valve replacement with the Epic Supra valve for severe aortic stenosis in a Japanese cohort. We retrospectively evaluated 65 patients who underwent aortic valve replacement using the Epic Supra valve for aortic stenosis at our department between May, 2011 and October, 2016. The mean follow-up period was 68.7 ± 32.7 months, and the follow-up rate was 89.2%. The mean age was 76.8 ± 5.3 years. The 1-, 5-, and 8-year survival rates were 96.9%, 79.4%, and 60.3%, respectively. The rates of freedom from valve-related events were 96.6% and 81.9% at 5 and 8 years, respectively. Four patients were diagnosed with structural valve deterioration (SVD), and reintervention was performed in two patients. The rates of freedom from SVD were 98.2% and 83.3% at 5 and 8 years, respectively, and the mean time to diagnosis of SVD was 72.5 ± 25.3 months. The mean pressure gradient (MPG) was 16.8 ± 6.0 mmHg postoperatively, 17.5 ± 9.4 mmHg at 5 years, and 21.2 ± 12.4 mmHg at 8 years (p = 0.08). The effective orifice area index (EOAI) was 0.95 ± 0.2 cm2/m2 immediately after surgery, 0.96 ± 0.27 cm2/m2 at 5 years, and 0.84 ± 0.2 cm2/m2 at 8 years (p = 0.10). An increase in MPG and decrease in EOAI were also observed, which may be associated with SVD. Follow-up after 5 years is important to determine if there is an increase.
RESUMEN
Ascending aorta thrombosis unaccompanied by an aneurysm or a primary hypercoagulable state is rare. We report a surgical case of ascending aorta thrombosis with multiple emboli. A 44-year-old woman visited the hospital for evaluation of dysarthria and was diagnosed with multiple cerebral infarcts. Contrast-enhanced computed tomography (CT) revealed a mass in the ascending aorta and the brachiocephalic artery. We performed emergency removal of the masses and endarterectomy with cardiopulmonary bypass under hypothermic circulatory arrest. Histopathological examination of the resected specimen showed thrombi. The patient had an uneventful recovery and was discharged 12 days postoperatively. No recurrent thrombus or hypercoagulable state was observed for 3 years postoperatively.
Asunto(s)
Enfermedades de la Aorta , Embolia , Trombosis , Femenino , Humanos , Adulto , Trombosis/complicaciones , Trombosis/diagnóstico por imagen , Enfermedades de la Aorta/complicaciones , Enfermedades de la Aorta/diagnóstico por imagen , Enfermedades de la Aorta/cirugía , Embolia/diagnóstico por imagen , Embolia/etiología , Embolia/cirugía , Aorta/diagnóstico por imagen , Aorta/cirugía , Puente CardiopulmonarRESUMEN
Mycotic aneurysm of the aortic arch is a rare, but critical entity. We reviewed our surgical experience of mycotic aneurysm of the aortic arch. Between January 2007 and December 2015, we operated on six patients who had mycotic aneurysm of the aortic arch. The mean age was 72 years old, and four males were included. Preoperative white blood cell count was 18,266/µl and C-reactive peptide was 18.5 µg/dl, respectively. The initial presentations included fever( n=2), hoarseness( n=2), weakness of a leg( n=1), dyspnea (n=1) and hemoptysis (n=1). Preoperative blood cultures were positive in three patients. All patients underwent a total aortic arch repair with a four-branched vascular tube, and five received pedicled omental grafting. One patient who did not receive pedicled omental grafting died of recurrence of infection on postoperative day 21, and the other died of multi-organ failure on postoperative day 77. We experienced tracheostomy( n=1), minor stroke( n=1), and atrial fibrillation( n=1). During the follow-up period, no recurrence of infection was observed in four survivors. Our surgical strategy is satisfactory to achieve good clinical outcomes.
Asunto(s)
Aneurisma Infectado , Aneurisma de la Aorta Torácica , Implantación de Prótesis Vascular , Procedimientos Endovasculares , Masculino , Humanos , Anciano , Aneurisma de la Aorta Torácica/cirugía , Aneurisma Infectado/diagnóstico por imagen , Aneurisma Infectado/cirugía , Resultado del Tratamiento , Estudios Retrospectivos , StentsRESUMEN
BACKGROUND: Mitral valve repair is preferred for pediatric mitral valve disease. However, it is technically difficult because of complex lesions, poor surgical exposure, and tissue fragility, especially in infants. We investigated the midterm outcomes of mitral valve surgery for mitral regurgitation in infancy. METHODS: We retrospectively reviewed 18 patients (aged <12 months old) undergoing mitral valve surgery for mitral regurgitation at our institution between October 2005 and March 2019. The patients had 10 acquired and 8 congenital valve lesions as follows: torn chordae (n = 6), leaflet prolapse (n = 4), posterior leaflet hypoplasia (n = 3), anterior leaflet cleft (n = 2), infective endocarditis (n = 1), papillary muscle rupture (n = 1), and hammock valve (n = 1). RESULTS: All patients initially underwent mitral valve repair. There was no operative mortality, and 1 case of late death. The median follow-up period was 7 years and 9 months. Reoperation was performed in 3 patients, re-repair (twice) in 1 patient with a hammock valve, and mitral valve replacement in 2 patients. Fifteen patients had at most mild mitral regurgitation at the last follow-up. A transmitral mean pressure gradient of over 5 mm Hg was observed in 3 cases, including the patient with a hammock valve. Postoperative mitral annular diameter increased within the normal range in all patients. Survival and reoperation-free rates at 5 and 10 years were 94.4% and 83.0%, respectively. CONCLUSIONS: Mitral valve repair for mitral regurgitation in infancy is safe and feasible with satisfactory midterm outcomes, even under serious preoperative conditions.
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Enfermedades de las Válvulas Cardíacas , Insuficiencia de la Válvula Mitral , Prolapso de la Válvula Mitral , Lactante , Humanos , Niño , Insuficiencia de la Válvula Mitral/congénito , Estudios Retrospectivos , Resultado del Tratamiento , Válvula Mitral/cirugía , Válvula Mitral/anomalías , Prolapso de la Válvula Mitral/diagnóstico por imagen , Prolapso de la Válvula Mitral/cirugía , Estudios de SeguimientoRESUMEN
A 73-year-old female who underwent aortic valve replacement with a biological valve, coronary artery bypass, and left atrial appendage closure had sudden onset of nausea and abdominal pain 43 days after surgery. She had a history of nonocclusive mesenteric ischemia on 4th postoperative day, for which conservative management was successfully carried out. A contrast-enhanced computed tomography(CT) was performed because a recurrence of nonocclusive mesenteric ischemia was suspected. It revealed a whirl sign in the small intestine, suggestive of small intestine volvulus. At the subsequent emergency laparotomy, volvulus caused severe congestion in the small intestine, aproximately 40 cm from the cecum. However, there was no evidence of transmural necrosis, and reduction of torsion notably improved blood supply to the small intestine. Her regular diet was resumed on 4th postoperative day, and her postoperative course was uneventful. Volvulus should be considered as a differential diagnosis in the setting of acute abdominal pain after open-heart surgery.
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Vólvulo Intestinal , Isquemia Mesentérica , Dolor Abdominal/diagnóstico , Dolor Abdominal/etiología , Anciano , Puente de Arteria Coronaria/efectos adversos , Femenino , Humanos , Vólvulo Intestinal/diagnóstico por imagen , Vólvulo Intestinal/etiología , Intestino Delgado/cirugía , Isquemia Mesentérica/diagnóstico por imagen , Isquemia Mesentérica/etiologíaRESUMEN
Coffin-Lowry syndrome is a rare X-linked disorder that shows a varied clinical presentation. We report cardiac involvement, particularly abnormalities of mitral valve morphology, in a 14-year-old male adolescent with a known diagnosis of Coffin-Lowry syndrome, who presented with easy fatigability. Echocardiography revealed severe mitral and moderate tricuspid regurgitation, and the papillary muscles were attached to the base of the left ventricle. We performed tricuspid annuloplasty and mitral valve repair using two artificial chordae and a semi-rigid full ring. The patient's postoperative course was uneventful. Postoperative echocardiography revealed reduced mitral regurgitation, and his cardiac failure improved.
Asunto(s)
Anuloplastia de la Válvula Cardíaca , Síndrome de Coffin-Lowry , Anuloplastia de la Válvula Mitral , Insuficiencia de la Válvula Mitral , Insuficiencia de la Válvula Tricúspide , Adolescente , Humanos , Masculino , Válvula Mitral/diagnóstico por imagen , Válvula Mitral/cirugía , Insuficiencia de la Válvula Mitral/diagnóstico por imagen , Insuficiencia de la Válvula Mitral/cirugía , Resultado del Tratamiento , Válvula Tricúspide/diagnóstico por imagen , Válvula Tricúspide/cirugía , Insuficiencia de la Válvula Tricúspide/diagnóstico por imagen , Insuficiencia de la Válvula Tricúspide/cirugíaRESUMEN
BACKGROUND: Several studies have reported high rates of structural valve deterioration (SVD) in the Trifecta valves. Herein, we analyzed the midterm results of the Trifecta valve and risk factors for early SVD. METHODS: We retrospectively reviewed the records of 110 patients who had undergone Trifecta implantation between January 2012 and December 2017. RESULTS: We encountered seven cases of Trifecta valve failure. We performed a redo aortic valve replacement in five patients and a transcatheter aortic valve replacement in two patients. The SVD rate was 4.8% at 5 years and 6.6% at 7 years. The mean pressure gradient and peak velocity on the first postoperative echocardiogram in patients with SVD were higher than those in patients without SVD. The SVD rates with and without patient-prosthesis mismatch (PPM) were 2.8% and 12.6% at 5 years and 2.8% and 20.0% at 7 years. PPM is a risk factor for SVD. Noncoronary cusp tears were observed in all patients who had undergone redo surgery. CONCLUSIONS: The most common cause of SVD was noncoronary cusp tear. Patients with PPM are at high risk of developing SVD.
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Estenosis de la Válvula Aórtica , Bioprótesis , Enfermedades de las Válvulas Cardíacas , Implantación de Prótesis de Válvulas Cardíacas , Prótesis Valvulares Cardíacas , Válvula Aórtica/cirugía , Estenosis de la Válvula Aórtica/etiología , Estenosis de la Válvula Aórtica/cirugía , Bioprótesis/efectos adversos , Enfermedades de las Válvulas Cardíacas/cirugía , Prótesis Valvulares Cardíacas/efectos adversos , Implantación de Prótesis de Válvulas Cardíacas/efectos adversos , Humanos , Diseño de Prótesis , Falla de Prótesis , Estudios Retrospectivos , Factores de RiesgoRESUMEN
Guide wire fracture is a rare, yet potentially life-threatening complication of percutaneous coronary intervention. A 65-years old man underwent emergent coronary angioplasty for myocardial ischemia. Percutaneous coronary intervention for the residual lesions of left anterior descending artery (LAD) was planned. The protection guide wire for left circumflex artery( LCx) was entangled in the stent in LAD. Despite many attempts, the wire could not be retrieved. Finally, the wire was fractured and the stent in LAD was deformed. The patient was sent to our service to remove the fractured wire. We performed urgent removal of the guide wire and coronary artery bypass grafting( CABG). The postoperative course was uneventful. The timing of surgical removal of the guide wire and the indication for coronary artery reconstruction should be discussed by heart team.
Asunto(s)
Angioplastia Coronaria con Balón , Enfermedad de la Arteria Coronaria , Anciano , Puente de Arteria Coronaria , Humanos , Masculino , Revascularización MiocárdicaRESUMEN
A 48-year-old female patient was transferred with dysarthria and left-sided hemiplegia. Contrast-enhanced computed tomography revealed occlusion of the first branch of the right middle cerebral artery, for which an emergency thrombectomy was successfully performed within 2 hours of patient's initial symptoms. Postoperatively, transthoracic echocardiography revealed a massive mobile left atrial mass, measuring approximately 65×30 mm, a part of which moved in and out of the mitral valve without significant mitral regurgitation. Embolisms to the kidneys and the spleen were demonstrated. Another emergency cardiac surgery was performed, 4 hours after the thrombectomy, to resect the mass from the fossa oval with the atrial septum;the defect was closed using autologous pericardium. The histopathological findings of the specimen were consistent with a myxoma. The patient completely recovered and was discharged when ambulatory. We have discussed the importance of the timing of surgical intervention in the context of patients undergoing cardiac surgery after a cerebral embolism.