RESUMO
BACKGROUND: Deep hypothermic circulatory arrest (DHCA) at ≤20°C for aortic arch surgery has been widely used for decades, with or without cerebral perfusion (CP), antegrade (antegrade cerebral perfusion [ACP]), or retrograde. In recent years nadir temperature progressively increased to 26°C-28°C (moderately hypothermic circulatory arrest [MHCA]), adding ACP. Aim of this multicentric study is to evaluate early results of aortic arch surgery and if DHCA with 10 min of cold reperfusion at the same nadir temperature of the CA before rewarming (delayed rewarming [DR]) can provide a neuroprotection and a lower body protection similar to that provided by MHCA + ACP. METHODS: A total of 210 patients were included in the study. DHCA + DR was used in 59 patients and MHCA + ACP in 151. Primary endpoints were death, neurologic event (NE), temporary (TNE), or permanent (permanent neurologic deficit [PND]), and need of renal replacement therapy (RRT). RESULTS: Operative mortality occurred in 14 patients (6.7%), NEs in 17 (8.1%), and PNDs in 10 (4.8%). A total of 23 patients (10.9%) needed RRT. Death + PND occurred in 21 patients (10%) and composite endpoint in 35 (19.2%). Intergroup weighed logistic regression analysis showed similar prevalence of deaths, NDs, and death + PND, but need of RRT (odds ratio [OR]: 7.39, confidence interval [CI]: 1.37-79.1) and composite endpoint (OR: 8.97, CI: 1.95-35.3) were significantly lower in DHCA + DR group compared with MHCA + ACP group. CONCLUSIONS: The results of our study demonstrate that DHCA + DR has the same prevalence of operative mortality, NE and association of death+PND than MHCA + ACP. However, the data suggests that DHCA + DR when compared with MHCA + ACP provides better renal protection and reduced prevalence of composite endpoint.
Assuntos
Aorta Torácica , Parada Circulatória Induzida por Hipotermia Profunda , Humanos , Aorta Torácica/cirurgia , Resultado do Tratamento , Parada Circulatória Induzida por Hipotermia Profunda/métodos , Encéfalo , Ponte Cardiopulmonar/métodos , Perfusão/métodos , Circulação Cerebrovascular , Estudos RetrospectivosAssuntos
Infecções por Coronavirus/epidemiologia , Hospitalização/estatística & dados numéricos , Pandemias/estatística & dados numéricos , Equipe de Assistência ao Paciente/organização & administração , Pneumonia Viral/epidemiologia , Cirurgiões , COVID-19 , Procedimentos Cirúrgicos Cardíacos/métodos , Infecções por Coronavirus/prevenção & controle , Feminino , Humanos , Controle de Infecções/métodos , Itália , Masculino , Pandemias/prevenção & controle , Papel do Médico , Pneumonia Viral/prevenção & controleRESUMO
Echocardiography is the most used imaging technique for the study of patients with mitral regurgitation because of its wide distribution, non-invasiveness and ability to provide diagnostic, functional, hemodynamic and prognostic evaluations. Also, echocardiography can provide essential information on surgical and percutaneous reparability of the regurgitant valve and can guide the surgical and interventional indications relative to valve repair. However, the echocardiographic study is not always appropriately performed in clinical practice and based on a surgery perspective. Therefore, the purpose of this article is to describe how to best use echocardiography for evaluation of patients with mitral regurgitation, highlighting the advantages and limitations of this technique before and after surgical or interventional repair.
Assuntos
Ecocardiografia , Insuficiência da Valva Mitral/diagnóstico por imagem , Procedimentos Cirúrgicos Cardíacos/métodos , Árvores de Decisões , Humanos , Insuficiência da Valva Mitral/cirurgiaRESUMO
BACKGROUND: Postoperative sternal wound complications are infrequent events that negatively affect recovery and may have serious consequences. Sternal wrapping, a technique of sternal care, has hemostatic properties without bone wax, and offers mechanical and microbiologic protection. METHODS: From February 1998 to December 2011, 258 patients in 2 Italian institutions underwent various cardiac surgery procedures with sternal wrapping in place, and were followed up for no less then 6 months. RESULTS: Two (0.8%) extremely compromised patients with ischemic sternal osteonecrosis and deep sternal wound infection required a sternal stabilizing procedure. Four (2%) other patients developed sternal wound complications that were treated entirely medically; 3 of them were very trivial, and 1 was an atypical mediastinitis without sternal involvement. Overall, 46.1% of patients (45.3% of isolated coronary artery bypass, 49.3% of isolated on-pump coronary artery bypass, and 18.2% of off-pump coronary artery bypass patients) were transfused. None of the complications was related to sternal wrapping, bleeding from the sternal edge, or sternal wound problems. CONCLUSIONS: Sternal wrapping showed a very low incidence and severity of sternal wound complications, with good prevention of sternal osteomyelitis. Hemostatic properties were satisfactory, with transfusion rates within an acceptable range.
Assuntos
Procedimentos Cirúrgicos Cardíacos , Técnicas Hemostáticas , Complicações Pós-Operatórias/prevenção & controle , Esternotomia , Cicatrização , Idoso , Perda Sanguínea Cirúrgica/prevenção & controle , Transfusão de Sangue , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Procedimentos Cirúrgicos Cardíacos/mortalidade , Feminino , Técnicas Hemostáticas/efeitos adversos , Técnicas Hemostáticas/mortalidade , Mortalidade Hospitalar , Humanos , Itália , Masculino , Mediastinite/prevenção & controle , Pessoa de Meia-Idade , Osteomielite/prevenção & controle , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/mortalidade , Fatores de Risco , Esternotomia/efeitos adversos , Esternotomia/mortalidade , Infecção da Ferida Cirúrgica/prevenção & controle , Fatores de Tempo , Resultado do TratamentoAssuntos
Fístula Arteriovenosa/etiologia , Lesões das Artérias Carótidas/etiologia , Artéria Carótida Externa/diagnóstico por imagem , Veias Jugulares/diagnóstico por imagem , Ferimentos não Penetrantes/complicações , Adulto , Fístula Arteriovenosa/diagnóstico por imagem , Fístula Arteriovenosa/cirurgia , Lesões das Artérias Carótidas/diagnóstico por imagem , Lesões das Artérias Carótidas/cirurgia , Artéria Carótida Externa/cirurgia , Humanos , Veias Jugulares/lesões , Angiografia por Ressonância Magnética , Masculino , RadiografiaRESUMO
As the population ages, an increasing number of patients with patent coronary grafts will require subsequent aortic valve replacement. Major operative problems include those associated with re-entry and, in particular, damage of the patent grafts. Between January 2007 and October 2008, 10 patients who had previous coronary bypass surgery underwent aortic valve replacement through upper j-shaped mini re-sternotomy. In all patients the previous grafts were patent. The operation was performed with normothermic cardiopulmonary bypass without dissection and temporary closure of the arterial and venous coronary bypass grafts. The mean age was 73.2+/-13.6 years. The patients had a mean of 2.8+/-0.6 bypass grafts. There were no intraoperative complications due to redo ministernotomy and at no time conversion to full re-sternotomy was necessary. No damage to the previous grafts was reported and the incidence of perioperative myocardial infarction was 0%. One patient required a pacemaker implantation for atrio-ventricular block. The in-hospital mortality was 0%. Aortic valve replacement in previous coronary bypass grafting can be performed safely with a mini re-sternotomy. This approach avoids extensive dissection, decreasing the risk of injuries to heart chambers and previous patent coronary grafts with low morbidity and mortality.
Assuntos
Valva Aórtica/cirurgia , Ponte de Artéria Coronária , Doenças das Valvas Cardíacas/cirurgia , Implante de Prótese de Valva Cardíaca , Esterno/cirurgia , Grau de Desobstrução Vascular , Adulto , Idoso , Idoso de 80 Anos ou mais , Ponte Cardiopulmonar , Feminino , Parada Cardíaca Induzida , Implante de Prótese de Valva Cardíaca/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Reoperação , Medição de Risco , Fatores de Tempo , Resultado do TratamentoRESUMO
Coronary anomalies can involve origin or distribution of the artery. Most of these anomalies are not clinically important. A single coronary artery arising from the right coronary sinus of Valsalva is an extremely rare anatomic anomaly. Usually coronary artery malformation is associated with other cardiac malformations and the diagnosis is made after birth. More rarely, coronary artery anomalies are an isolated and asymptomatic cardiac malformation.
Assuntos
Síndrome Coronariana Aguda/diagnóstico por imagem , Angiografia Coronária , Anomalias dos Vasos Coronários/diagnóstico por imagem , Vasos Coronários , Seio Aórtico/anormalidades , Seio Aórtico/diagnóstico por imagem , Síndrome Coronariana Aguda/etiologia , Idoso , Anomalias dos Vasos Coronários/complicações , Humanos , MasculinoRESUMO
Systemic arterial supply from the descending thoracic aorta to the basal segment of the left lower lobe without a pulmonary arterial supply is a rare congenital anomaly within the spectrum of the sequestration lung disease. We report a case of a young man with anomalous systemic arterial supply to a normal left lower lobe referred to our department because of recurrent haemoptysis who underwent a successful left lower lobectomy.
Assuntos
Aorta Torácica/anormalidades , Sequestro Broncopulmonar/patologia , Pulmão/irrigação sanguínea , Artéria Pulmonar/anormalidades , Humanos , Masculino , Adulto JovemRESUMO
OBJECTIVE: To review our 12-year experience in video-assisted thoracoscopic surgery (VATS) for patent ductus arteriosus. METHODS: VATS was performed in 743 patients. Three groups were compared: 24 low-birth-weight infants (LBWIs), 676 children between 2.5-25 kg and 43 boys > 25 kg. A diameter of > 8 mm was the main contraindication. For 85 consecutive patients, hospital stay underwent cost analysis. RESULTS: Median age was 1.6 years (range 5 days-33 years) and median weight 9.0 kg (range 1.2-65 kg). Mortality was nil. Median operative time was 20 min and hospital stay 2 days. Residual patency at discharge was 0% in LBWIs, 0.7% in children, and 4.7% in boys (P = NS) and 0, 0.3, and 4.7% at follow-up (P = 0.001). Persistent recurrent laryngeal nerve dysfunction was recorded in 4.2% of LBWIs, 0.3% of children and 0% of boys (P = 0.012). Total mean cost was Euro 5954 +/- 2110. CONCLUSIONS: The success rate of VATS clipping compares favorably with the thoracotomic approach but without chest wall trauma and it may have a very favorable cost-effective therapeutic balance compared to transcatheter techniques.
Assuntos
Permeabilidade do Canal Arterial/cirurgia , Cirurgia Torácica Vídeoassistida , Adolescente , Adulto , Distribuição por Idade , Criança , Pré-Escolar , Permeabilidade do Canal Arterial/economia , Feminino , Custos Hospitalares , Humanos , Lactente , Recém-Nascido de Baixo Peso , Recém-Nascido , Itália , Tempo de Internação , Masculino , Análise Multivariada , Complicações Pós-Operatórias/epidemiologia , Cirurgia Torácica Vídeoassistida/economia , Toracotomia , Paralisia das Pregas Vocais/epidemiologiaRESUMO
Postoperative pain control still represents a major challenge in every surgical field. Bupivacaine wound infiltration is frequently used to reduce the pain related to the surgical incision itself. In this randomized study, we investigated the efficacy of bupivacaine local anesthesia after median sternotomy to reduce postoperative pain. Forty-seven patients undergoing major cardiac surgery procedures were allocated randomly to group A (bupivacaine wound infiltration 0.5%; 10 mL, followed by continuous infusion: 10 mg/24 H) or to group C (controls). Extubation time, postoperative arterial blood gases, postoperative pain (assessed by means of a visual analog scale), and morphine consumption were the endpoints of the study. Patients of group C were extubated earlier; blood gases and VAS values were similar in both group. Bupivacaine local analgesia did not improve postoperative pain control after median sternotomy.
Assuntos
Anestésicos Locais/uso terapêutico , Bupivacaína/uso terapêutico , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Dor Pós-Operatória/prevenção & controle , Esterno/cirurgia , Toracotomia/efeitos adversos , Falha de Tratamento , Idoso , Anestésicos Locais/farmacologia , Bupivacaína/farmacologia , Humanos , Pessoa de Meia-Idade , Medição da DorRESUMO
We have developed a technique that enables robotic aortic valve replacement with port access via a small right anterior thoracotomy and minimally invasive aortic cross clamping. The procedure is performed under video guidance with all the annular sutures placed with the robot. In the case we report, the patient's postoperative course was extremely simple and pain was minimal. We believe that this is the first reported aortic valve replacement using robotic technology and that it opens a new field of application for robotic assisted surgery.