Giant Aneurysm of In Situ Saphenous Vein Graft.

We report a case of a symptomatic and rapidly expanding aneurysm of an in situ saphenous vein graft in a 70-year-old man with extensive prior open and endovascular procedures for aneurysmal disease. He was found to have full-length aneurysmal dilation with rapid progression over the course of 6 months. Successful ligation and exclusion with subtotal excision of the aneurysmal segment was performed, and revision bypass was foregone because of adequate distal perfusion via collateralization. This rare complication of autologous vein bypass graft typically occurs at the anastomoses and merits aneurysmorrhaphy or ligation. Far less common is the scenario of nonanastomotic, true aneurysmal dilation of the entire conduit such as the current patient. Surgical intervention via open, endovascular, or a combination thereof is warranted for rapidly growing or symptomatic defects and those yielding distal malperfusion.

Repair of contained ventricular rupture with infected intrapericardial thrombus.

Contained left ventricular rupture, or pseudoaneurysm, is a rare entity resulting from adhesions confining the defect to a localized portion of the pericardial space. Concomitant infection is even more infrequent. We present the first-known case of a patient with an infected intrapericardial thrombus from a left ventricular rupture.

Temporal trends and predictors of surgical ablation for atrial fibrillation across a multistate healthcare system.

BACKGROUND: Multiple class I and class IIa recommendations exist related to surgical ablation (SA) of atrial fibrillation (AF) in patients undergoing cardiac surgery. OBJECTIVE: Examine temporal trends and predictors of SA for AF in a large US healthcare system. METHODS: We retrospectively analyzed data from the Society for Thoracic Surgery (STS) Adult Cardiac Surgery Database for 21 hospitals in the Providence St. Joseph Health system. All patients with preoperative AF who underwent isolated coronary artery bypass graft (CABG) surgery, isolated aortic valve replacement (AVR), AVR with CABG surgery (AVR+CABG), isolated mitral valve repair or replacement (MVRr), and MVRr with CABG surgery (MVRr+CABG) from July 1, 2014, to March 31, 2020 were included. Temporal trends in SA were evaluated using the Cochran-Armitage trends test. A multilevel logistic regression model was used to examine patient-, hospital-, and surgeon-level predictors of SA. RESULTS: Among 3124 patients with preoperative AF, 910 (29.1%) underwent SA. This was performed most often in those undergoing isolated MVRr (n = 324, 44.8%) or MVRr+CABG (n = 75, 35.2%). Rates of SA increased over time and were highly variable between hospitals. Years since graduation from medical school for the primary operator was one of the few predictors of SA: odds ratio (95% confidence interval) = 0.71 (0.56-0.90) for every 10-year increase. Annual surgical (both hospital and operator) and AF catheter ablation volumes were not predictive of SA. CONCLUSION: Wide variability in rates of SA for AF exist, underscoring the need for greater preoperative collaboration between cardiologists, electrophysiologists, and cardiac surgeons.

Single-Incision Thoracoscopic Left Atrial Appendage Ligation: First Reported Experience.

Atrial fibrillation is an increasingly prevalent entity faced by cardiac surgeons. While oral anticoagulation therapy aims to reduce the risk of thromboembolic events patients may desire to discontinue these medications or develop contraindications to their use. Left atrial appendage ligation permits stoppage of oral anticoagulation while also reducing the risk of cerebrovascular events. This manuscript describes the techniques employed in the first reported successful uniportal/single-incision, thoracoscopic epicardial left atrial appendage ligation.

Single-Ventricle Palliation in a 4-Year-Old With Ehlers-Danlos Syndrome.

We report the case of a 4-year-old boy with Ehlers-Danlos syndrome undergoing single-ventricle palliation for an unbalanced atrioventricular canal defect. No reports of single-ventricle palliation in the setting of connective tissue disorders exist in the current literature. Unique findings on the patient's preoperative imaging included a disproportionately large neoaortic root and a regurgitant atrioventricular valve, which may foretell the need for future intervention.