Hybrid approach for cerebral protection in open-heart surgery: Case series.

BACKGROUND: Stroke remains one of the most important complications of cardiac surgery and occurs in 2.2% after open-heart procedure. It is associated with significant morbidity and mortality. The use of a cerebral protection system during transcatheter aortic valve implantation may be associated with a lower risk of periprocedural strokes, and mortality at 30 days. The aim of the present study was to assess the safety and feasibility of this device in patients at high risk for stroke during open cardiac surgery. METHODS: We present six patients with a high risk of perioperative stroke who underwent placement of Sentinel cerebral protection system during various open-heart operations between 2018 and 2021. RESULTS: The system was successfully deployed, and debris was retrieved in all patients. There was no device-related complication or development of ischemic stroke postoperatively. One patient suffered from intracranial hemorrhage due to peri-operative coagulopathy. CONCLUSIONS: We demonstrated the feasibility and safety of this hybrid approach with a high debris capture rate. It encourages further study to evaluate the benefits of the Sentinel cerebral protection system in reducing stroke and mortality in selected patients undergoing open-heart surgery.

Late tricuspid surgery: predicting outcome with computed tomography.

Tricuspid regurgitation can progressively worsen years after left-sided heart valve surgery, requiring surgical intervention for which the prognostic factors are unclear. This study aimed to assess the prediction of surgical outcome using right ventricular function obtained from computed tomography. We prospectively enrolled 24 patients who underwent isolated tricuspid repair or replacement from 2005 to 2008. Right ventricular computed tomography was carried out before surgery. The primary endpoint was survival with symptomatic improvement after one year. Twelve patients survived with improvement of at least one New York Heart Association functional class, and 12 died or had no symptomatic improvement. All baseline characteristics, echocardiogram data, and surgical details were similar in both groups. Right ventricular computed tomography parameters including end-systolic volume, indexed end-systolic volume, end-diastolic volume, and indexed end-diastolic volume were significantly different between the two groups. We concluded that right ventricular function assessed by computed tomography can predict the surgical outcome in patients undergoing surgery for isolated late tricuspid regurgitation.

Surgical treatment for empyema thoracis: is video-assisted thoracic surgery "better" than thoracotomy?

BACKGROUND: Operations for empyema thoracis are conventionally performed by open thoracotomy, whereas the video-assisted thoracic surgery (VATS) approach remains controversial. This study compares the radiologic and functional outcomes of decortication using the two approaches. METHODS: During a 5-year period, 77 consecutive patients underwent decortication for empyema thoracis at two university teaching hospitals. The choice of surgical approach was decided by surgeon preference. Preoperative and postoperative empyema management was the same in all patients. Postoperative radiologic improvements were graded by a radiologist blinded to the approach used. Functional improvements were assessed by a questionnaire-based survey conducted at a mean of 36 months after the surgical procedure. RESULTS: The VATS approach was used in 41 patients and the thoracotomy approach in 36 patients. Patients in the two groups had similar preoperative demographic and clinical features. No patients required conversion from VATS to thoracotomy or reintervention for empyema. Intraoperative blood loss, duration of chest drain, lengths of hospital stay, and postoperative complication rates were all similar in the two groups. The mean operation time in the VATS group was significantly shorter (2.5 versus 3.8 hours, p < 0.001). Decortication using both approaches gave similar degrees of postoperative radiologic and functional improvements. Of the 42 patients available for follow-up, the 21 who received the VATS approach reported significantly less postoperative pain (p = 0.04), greater satisfaction with the wounds (p < 0.0001), and greater satisfaction with the operation overall (p = 0.006). CONCLUSIONS: VATS allows equally effective decortication for empyema as thoracotomy. However, the VATS approach gives less pain and greater patient acceptance.

Mitral valve annuloplasty with Carpentier-Edwards physio ring: mid-term results.

The mid-term results of mitral valve repair with the Carpentier-Edwards Physio annuloplasty ring were assessed in 97 consecutive patients in a single tertiary-referral cardiothoracic surgical center. The mean follow-up time was 3.9 years (range, 1 month to 8.9 years). Most patients were in functional class II and III before the operation. Ejection fraction was < 40% in 8 patients. Causes of mitral regurgitation included degenerative disease (66%), infective endocarditis (13.4%), rheumatic disease (10.3%), and ischemic heart disease (9.3%). Thirty-day mortality was 2.1%. Actuarial survival and freedom from re-operation at 8 years were 91% and 90.8%, respectively. The only significant risk factor for re-operation was residual mitral regurgitation. Four patients suffered thromboembolic complications, giving an overall event-free survival of 93% +/- 3.7% during the follow-up period. The Carpentier-Edwards Physio ring provides safe and effective repair of mitral regurgitation on mid-term follow-up.