Association between PET/CT Scan Findings, Treatment, and Cancer Incidence in a Cohort of AAA Patients.

Background: Abdominal aortic aneurysm (AAA) is a chronic inflammatory disease that poses several challenges. Given the increasing evidence that AAA patients are more likely to develop cancer and the importance of its early detection, we strived to develop a non-invasive tool based on serial FDG-PET/CT scan examinations to identify, among AAA patients, those at risk of cancer. Methods: Between 2006 and 2011 we recruited 149 AAA patients, free of cancer at baseline, and followed them until the end of 2021. All patients underwent an FDG-PET/CT scan at inclusion and possibly more scans during follow-up. At each medical imaging examination, the aneurysmal FDG uptake was recorded. Patients were stratified based on their aortic wall PET status (negative/positive). Any occurrence of cancer was reported. A Cox regression analysis and competing-risk modeling were applied to the data. Results: The proportion of AAA patients who developed cancer was 31.5% (mean time to diagnosis was 5.7 ± 3.4 years) and the death rate was 59%. A difference in cancer incidence between PET+ and PET- patients was detected (46.8% vs. 27.3%; HR = 1.96, 95%CI: 1.07-3.57, p = 0.028). Moreover, AAA patients undergoing surgical treatment had a lower risk of cancer than unoperated patients (28% vs. 50%; HR = 0.41, 95%CI: 0.21-0.80, p = 0.009). Conclusions: In AAA patients, diagnostic imaging with an FDG-PET/CT scan can help identify those patients at a higher risk of developing cancer. Moreover, the higher cancer risk in non-surgically treated patients calls for further analysis of associations between aneurysm growth and malignant disease.

Preoperative continuation of aspirin before isolated heart valve surgery and postoperative bleeding and transfusion: a single-center retrospective study.

BACKGROUND: The risks and benefits of preoperative aspirin continuation in patients undergoing isolated heart valve replacement surgery are unclear. We investigated the effect of aspirin continuation on the risk of bleeding and transfusion in these patients. METHODS: In this single center, retrospective study, among 474 adult patients who underwent isolated heart valve surgery between April 2013 and June 2018, 269 continued aspirin within 5 days before surgery (aspirin group) and 205 patients did not take or stopped aspirin no later than 5 days before surgery (non-aspirin group). The chi-square test, the Mann-Whitney U-test, and the Student's T-test were used to compare data between the groups. Univariate and Multivariate logistic regressions were used to assess crude and adjusted relationships between outcome and exposure. RESULTS: The primary outcome, red blood cell (RBC) transfusion, occurred in 59 patients (22%) of the aspirin group and in 24 patients (12%) of the non-aspirin group (p = 0.004). After adjustment for confounding factors, continuation of aspirin was no longer associated with RBC transfusion (aOR1.8;95%CI,0.98-3.2;p = 0.06). The amount of allogenic blood products, the incidence of surgical re-exploration for bleeding, the volume of re-transfused cell-saved blood, and the cumulative chest tube drainage during the first 24 postoperative hours were similar between groups. CONCLUSION: Preoperative continuation of aspirin in patients undergoing isolated heart valve surgery is neither associated with a higher incidence of RBC transfusion, nor with larger perioperative blood loss, or more frequent surgical revision for bleeding. TRIAL REGISTRATION: Clinicaltrials.gov (NCT05151796).

On-table Extubation After Minimally Invasive Cardiac Surgery: A Retrospective Observational Pilot Study.

OBJECTIVE: To assess the safety of "on-table" extubation after minimally-invasive heart valve surgery. DESIGN: A single-center retrospective observational study. SETTING: At a tertiary referral academic hospital. PARTICIPANTS: Patients who underwent nonemergent isolated heart valve surgery through a minithoracotomy approach between January 2016 and August 2021. INTERVENTION: All patients were treated by 1 of the 6 cardiac anesthesiologists of the hospital. Only some of them practiced "on-table" extubation, and the outcome of patients extubated "on-table" was compared to those extubated in the intensive care unit (ICU). MEASUREMENT AND MAIN RESULTS: The primary outcome was the occurrence of any postoperative respiratory complication during the entire hospital stay. Secondary outcomes included the use of inotropes and vasopressors, de novo atrial fibrillation, and lengths of stay in the ICU and the hospital. A total of 294 patients met inclusion criteria, of whom 186 (63%) were extubated "on-table." Cardiopulmonary bypass duration was significantly longer, and moderate intraoperative hypothermia was significantly more frequent in patients extubated in the ICU. After adjustment for these confounders and for the European System for Cardiac Operative Risk Evaluation (EuroSCORE) II using a multivariate logistic model, no association was found between the extubation strategy and postoperative pulmonary complications (adjusted odds ratio = 0.84; 95% CI = 0.40-1.77; p = 0.64). "On-table" extubation was associated with a lower risk of postoperative pneumonia and fewer vasopressors requirements. CONCLUSION: "On-table" extubation was not associated with an increased incidence of respiratory complications. A randomized controlled trial is warranted to confirm these results and determine whether "on-table" extubation offers additional benefits.

[Aortic valve repair surgery : state of the art and clinical experience of the university hospital center of Liege]. / Chirurgie de réparation de la valve aortique : statut actuel de la technique et expérience clinique du CHU de Liège.

In the past 20 years, there has been a real development of aortic valve repair techniques with an increasing number of publications describing the long-term benefits of aortic valve repair in terms of survival, freedom from major adverse valve related-events and reoperations. Aortic valve repair can now be considered as a valuable alternative to prosthetic valve replacement in patients with dystrophic ascending aorta pathology associated or not to aortic insufficiency with pliable leaflets. In this paper, the authors describe the state of the art of aortic valve repair and present their clinical experience with aortic valve repair surgery in the university hospital center of Liege from April 2021 to September 2022.

Les techniques de réparation de la valve aortique se sont considérablement développées ces 20 dernières années. Plusieurs publications confirment les bénéfices à long terme de ces techniques en termes de survie, d'absence de complications majeures et de réinterventions pour récidive d'insuffisance aortique. La réparation de la valve aortique apparaît ainsi comme une véritable alternative au remplacement valvulaire aortique prothétique chez certains patients qui présentent une pathologie dystrophique de l'aorte ascendante associée ou non à une insuffisance aortique sur valve souple. Dans cet article, les auteurs parcourent la littérature actuelle sur le sujet et décrivent leur expérience clinique avec la chirurgie de réparation de la valve aortique au sein du centre hospitalier universitaire de Liège d'avril 2021 à septembre 2022.

Catamenial pneumothorax, a commonly misdiagnosed thoracic condition: case report.

A 43-year-old woman presented with right-sided chest discomfort associated with dyspnea. The symptoms were related to the menstrual cycle and the patient has already presented several similar episodes. The Chest computed tomography (chest-CT) showed a partial right pneumothorax. A thoracoscopy was performed and demonstrated some diaphragmatic fenestrations. The diagnosis of a catamenial pneumothorax was established. The catamenial pneumothorax is a rare condition affecting the women in the reproductive period and is located most of the time in the right-side. The treatment is mainly surgical with the realization of a thoracoscopy. However, a medical treatment may be sometimes necessary.

Surgery of the ascending aorta via a right anterior minithoracotomy: initial surgical experience of a single center.

OBJECTIVES: Full median sternotomy (FMS) is the common surgical access for patients undergoing replacement of the ascending aorta (AA) with or without aortic valve replacement (AVR). The right anterior mini-thoracotomy (RAMT) approach has been increasingly adopted for AVR. This approach has been shown to decrease blood loss and hospital length of stay (LOS) compared with FMS. The RAMT approach may also be beneficial in selected patients requiring AA procedures with or without AVR. We present our initial clinical experience of patients who have undergone a RAMT for supracommissural replacement of the tubular AA with or without AVR. METHODS: This is a single-center retrospective review of 10 patients who underwent an elective RAMT for replacement of the tubular AA with or without AVR between November 2019 and January 2022. Clinical outcomes evaluated include 30-day mortality, intensive care and hospital LOS, time to extubation, operative times, as well as postoperative complications such as stroke and bleeding. RESULTS: Median cross-clamp and cardiopulmonary bypass times were 109 and 148 min, respectively. Median time to extubation was 2.5 h and median intensive care unit and hospital stay were 2 and 10 days, respectively. There were two re-thoracotomies for postoperative bleeding and two cases of sub-xiphoidal pericardial drainage for pericardial effusion. There were no strokes and no in-hospital nor 30-day mortalities. CONCLUSIONS: The replacement of the AA with or without concomitant AVR can be performed through a RAMT in carefully selected patients. However, the safety of this approach, as compared to full/partial median sternotomy, remains to be proven.

Key questions: Can ascending aorta surgery with or without aortic valve replacement be safely performed via right thoracotomy?Key Findings: A good experience of right thoracotomy approach helps performing ascending aorta surgery via that access in carefully selected patients.Take home message: Center with expertise in right thoracotomy can performed ascending aorta surgery through that access in carefully selected patients. However, the safety of this approach, as compared to full or partial median sternotomy, remains to be proven.

Abdominal Aortic Aneurysm in Heart Transplant Recipients: New Insights from a 30-year Experience at a Single Center.

BACKGROUND: The improvement in survival rates for heart transplant recipients (HTRs) has increased their risk of developing extracardiac diseases such as abdominal aortic aneurysms (AAAs). The purposes of this study were to evaluate the prevalence and to describe the clinical features and natural history of AAA in HTRs. METHODS: A retrospective review of all patients (375) who underwent heart transplantation (HT) at our center over a 32-year period (1983-2015) was carried out. RESULTS: We identified 20 patients (5.3%) with AAA. All but one patient were male (95%), and most of them (80%) had a history of ischemic heart disease (IHD) prior to transplantation. The mean age of the patients with AAA at transplant was 57.2 ± 7.3 years (range: 42-62 years). Seven of the 20 patients with AAA already had an AAA (30-55 mm) prior to transplantation. The average aneurysm size at the time of diagnosis was 40.9 ± 9.6 mm, and the average patient age at the time of diagnosis was 62.2 ± 8.3 years. The mean linear expansion rate was 10.6 ± 2.12 mm/y, and the exponential expansion rate was 0.220 ± 0.040 year-1, respectively. The median follow-up time was 5.4 years (range 0.1-27.4 years). The median survival was 143 months (95% confidence interval (CI) 65 to 180 months) for the 20 HTRs with AAA and 68.8 months (95% CI 46 to 88 months) for the other HTRs. CONCLUSIONS: The natural history of AAA in HTR is characterized by an increased expansion rate. Male HTR with end-stage IHD are particularly at risk and should be closely followed-up after HT.

Mycotic aneurysm of the ascending aorta due to Escherichia coli: a case report.

Ascending aorta mycotic aneurysm is a rare entity. It is a life-threatening condition because of the possibility of aortic dissection, or rupture. Escherichia coli is recognised as an uncommon cause of aortic mycotic aneurysm. An 81-year-old woman with a history of Escherichia coli pyelonephritis 4 months previously, was admitted to our centre for a mycotic aneurysm of the ascending aorta caused by Escherichia coli. She was successfully treated by urgent in situ replacement of the ascending aorta with a cryopreserved homograft, combined with antibiotics. Although infrequent, Escherichia coli mycotic aneurysm should be suspected in older patients with atherosclerosis and who developed septicaemia. Prompt treatment with a combination of appropriate antibiotics and surgery is required.

Transplantation of donor hearts after circulatory death using normothermic regional perfusion and cold storage preservation.

OBJECTIVES: Hearts donated after circulatory determination of death are usually preserved with normothermic machine perfusion prior to transplantation. This type of preservation is costly, requires bench time adding to warm ischaemia, and does not provide a reliable evaluation of the unloaded donor heart. We report on 4 successful donation after circulatory death (category III) hearts transplanted after thoraco-abdominal normothermic regional perfusion (NRP) and static cold storage. METHODS: After life sustaining therapy was withdrawn and death was declared, perfusion to thoraco-abdominal organs was restored using extracorporeal circulation via cannulas in the femoral artery and vein and clamping of supra-aortic vessels. After weaning from extracorporeal circulation, cardiac function was assessed. Once approved, the heart was retrieved and stored using classic static cold storage. Data are expressed as median [min-max]. RESULTS: Donor and recipient ages were 44 years [12-60] (n = 4) and 53 years [14-64] (n = 4), respectively. Time from the withdrawal of life sustaining therapy to start of NRP was 22 min [18-31]. Cold storage time was 72 min [35-129]. Thirty-day survival was 100% with a left ventricle ejection fraction of 60% [50-60]. CONCLUSIONS: Donation after circulatory death heart transplantation using thoraco-abdominal NRP and subsequent cold storage preservation for up to 129 min was safe for 4 procedures and could be a way to expand the donor heart pool while avoiding costs of machine preservation.

Streptococcus agalactiae infective endocarditis: analysis of eight surgical cases from a single centre.

BACKGROUND: Streptococcus agalactiae (GBS) infective endocarditis (IE) is a rare clinical entity. It is associated with a high mortality rate compared to other streptococci endocarditis. The aim of this study is to define the clinical characteristics, treatment and outcomes of a series of eight non-pregnant adults with GBS IE managed by a combination of antibiotics and surgery at our institution. METHODS: We retrospectively reviewed the medical records of all adult patients with a definite diagnosis of IE by Duke modified criteria and who underwent surgery at our centre between January 2008 and December 2018. RESULTS: A total of 190 patients underwent surgery for IE during the study period. Eight cases of GBS IE were identified, including six males and two females. The mean aged was 54 years (range, 32-68). Seven cases suffered native valve endocarditis and one involved an aortic bioprosthesis. Seven patients had underlying comorbidities. Furthermore, four patients had experienced serious complications. Of these, the most common were heart failure, septic shock, and cerebral emboli. Vegetations tended to be large, very mobile, and pedunculated. Most of the patients were treated with penicillin plus an aminoglycoside. Surgery was emergently performed in one patient and urgently performed in seven patients. In- hospital mortality rate was 37.5%. CONCLUSION: GBS IE is a virulent disease with an aggressive clinical course. It mostly affects patients with debilitating diseases. Early surgery should be considered to prevent the development of serious complications. However, overall mortality rate remains high despite surgical treatment.

Recurrent cardiac intimal sarcoma misdiagnosed as a myxoma or malignant transformation of a cardiac myxoma?

Cardiac intimal sarcoma is extremely rare and aggressive primary malignant cardiac tumors. Here, we reported the case of a young man initially operated for a tumor of the left atrium, causing a dynamic obstruction of the mitral valve and (mis-)diagnosed as a myxoma at the histopathological analysis. Patient presented a local recurrence at 3 months and was reoperated. Pathology revealed this time the presence of an intimal sarcoma. Patient received adjuvant chemotherapy. Despite a good local control, the 1-year follow-up positron emission tomography scan revealed the presence of a metastasis in the left adrenal gland that was surgically resected. This article aims to highlight the risk of misdiagnosis in case of cardiac tumors, the hypothetical concept of malignant transformation of a cardiac myxoma, the aggressive course of the extremely rare cardiac intimal sarcoma, and the therapeutic modalities available to treat this pathology.

Surgical management of Staphylococcus capitis prosthetic valve infective endocarditis: Retrospective review of a 10-year single center experience and review of the literature.

BACKGROUND: Staphylococcus capitis (S. capitis) is a subtype of coagulase-negative staphylococci and a commensal of the skin of the human scalp and forehead. S. capitis has been occasionally reported in infective endocarditis and rarely in prosthetic valve endocarditis (PVE). The purpose of this report is to present the clinical course and the surgical management of a series of four patients with S. capitis PVE. METHODS: The medical records of 190 adult patients with a definite diagnosis of infective endocarditis by the Duke modified criteria and who underwent surgery at our center between January 2008 and December 2018 were retrospectively reviewed. RESULTS: There were four cases of S. capitis infective endocarditis among 190 patients. All were male with an average age of 70.25 years (range, 58-80 years). The four cases were PVE: 3 aortic (1 mechanical and 2 biological bioprostheses) and 1 mitral (bioprosthesis). Their mean Euroscore II was 32.43 (range, 9.19-50.8). Three patients had underlying diseases (diabetes mellitus=2, chronic obstructive pulmonary disease=3, chronic kidney disease=1, peripheral arterial disease=2, ischemic heart disease=1, dilated cardiomyopathy=1). Preoperative clinical presentation was characterized by the occurrence of sepsis in three patients and heart failure and sepsis in one patient. Two patients presented with vegetation (mitral bioprosthesis, aortic bioprosthesis). A prosthetic dehiscence was present in all patients, and two presented with a localized annular abscess. All but one patient received triple antibiotic treatment with vancomycin plus rifampicin plus gentamycin. Surgery was performed on an urgent basis in all patients, and the in-hospital mortality rate was 50%. CONCLUSIONS: While limited by the small number of patients, our series highlights the aggressive clinical course of S. capitis PVE with a mortality rate close to that of Staphylococcus aureus PVE. Therefore, early surgical management is recommended to improve the clinical outcome of this serious disease.

Surgical aortic valve replacement for stenosis of TAVI device.

We here report the case of a stenosis of the CoreValve® system due to reduced mobility of prosthesis cusps for which a surgical replacement of the aortic valve was proposed. The exact mechanism leading to this impaired mobility of the leaflets is yet to be determined. We also underline the fact a transcatheter aortic valve implantation (TAVI) device can be replaced by a surgical replacement without excessive operative risks despite the patient being initially considered as high-risk.

Infected abdominal aortic aneurysm due to Escherichia coli.

Early diagnosis of infected abdominal aortic aneurysm (IAAA) is still a medical challenge due to its diverse and non-specific symptoms and signs. The most common responsible pathogens are Salmonella, Staphylococcus, Campylobacter and Streptococcus species. The authors report the case of a 67-year-old man, admitted for high fever and finally diagnosed with Escherichia coli (E.coli)-related IAAA. The IAAA ruptured during the general anaesthesia induction, leading to an emergency surgery. The authors successfully proceeded to an open aneurysmectomy with extensive debridement and in situ graft replacement. This case emphasizes the potential for rapid IAAA expansion, its high-rupture risk and the importance of computed tomography as a diagnostic tool.

Long-term clinical and echocardiographic follow-up of the Freestyle stentless aortic bioprosthesis.

BACKGROUND: Stentless aortic bioprostheses were designed to provide enhanced hemodynamic performance and potentially greater longevity. The present report describes the outcomes of patients with the Freestyle stentless bioprosthesis followed for ≤18 years. METHODS AND RESULTS: Between 1993 and 2011, 430 patients underwent primary aortic valve replacement with a Freestyle bioprosthesis in the subcoronary position. Mean age was 68.2 ± 8.2 years. All of the clinical and echocardiographic data were collected prospectively. Mean overall follow-up was 9.1 ± 4.4 years and was complete in all of the patients. In-hospital mortality was 3.5% (n=15). Overall, 10- and 15-year survival were 60.7% and 35.0%, respectively. Fifty-one patients required reoperation during follow-up, including 27 for structural valve deterioration (SVD). Overall, freedom from reoperation was 91.0% and 75.0% at 10 and 15 years, whereas freedom from reoperation for SVD was 95.9% and 82.3%, respectively. At 10 and 15 years, freedom from reoperation for SVD was 94.0% and 62.6% for patients <60 years of age and 96.3% and 88.4% for patients ≥60 years of age (P=0.002). The median time to explant for SVD was 10.7 years. SVD presented mostly as acute, severe aortic insufficiency attributed to leaflet tear (77.8%). The independent risk factors for reoperation for SVD were age <60 years (P=0.001) and dyslipidemia (P=0.02). CONCLUSIONS: Aortic valve replacement with the Freestyle bioprosthesis in a subcoronary position provides good long-term clinical and echocardiographic outcomes for patients >60 years of age. Severe aortic insufficiency with leaflet tear is the major mode of SVD leading to reoperation in these patients.

Carcinoid tumor of the appendix: a consecutive series from 1237 appendectomies.

AIM: To report the experience of the CHU Sart Tilman, University of Liege, Belgium, in the management of appendiceal carinoid tumor. METHODS: A retrospective review of 1237 appendectomies performed in one single centre from January 2000 to May 2004, was undertaken. Analysis of demographic data, clinical presentation, histopathology, operative reports and outcome was presented. RESULTS: Among the 1237 appendectomies, 5 appendiceal carcinoid tumors were identified (0.4%) in 4 male and 1 female patients, with a mean age of 29.2 years (range: 6-82 years). Acute appendicitis was the clinical presentation for all patients. Four patients underwent open appendectomy and one a laparoscopic procedure. One patient was reoperated to complete the excision of mesoappendix. All tumors were located at the tip of the appendix with a mean diameter of 0.6 cm (range: 0.3-1.0 cm). No adjuvant therapy was performed. All patients were alive and disease-free during a mean follow-up of 33 mo. CONCLUSION: Appendiceal carcinoid tumor most often presents as appendicitis. In most cases, it is found incidentally during appendectomies and its diagnosis is rarely suspected before histological examination. Appendiceal carcinoid tumor can be managed by simple appendectomy and resection of the mesoappendix, if its size is

Concurrent coronary and carotid artery surgery: factors influencing perioperative outcome and long-term results.

AIMS: To assess risk factors for early and late outcome after concurrent carotid endarterectomy (CEA) and coronary artery bypass grafting (CABG). METHODS AND RESULTS: Records of all 311 consecutive patients having concurrent CEA and CABG from 1989 to 2002 were reviewed, and follow-up obtained (100% complete). In the group (mean age 67 years; 74% males), 62% had triple-vessel disease, 57% unstable angina, 31% left main coronary stenosis, 19% congestive heart failure, and 35% either a history of vascular procedures or existing vasculopathies. Preoperative assessment revealed transient ischaemic attack in 16%, stroke in 7%, and bilateral carotid disease in 20%. There were 7% emergent and 19% urgent operations, and ascending aorta was described as atheromatous or calcified in 21%. Hospital death occurred in 19 patients, myocardial infarction in seven, and permanent stroke in 12. Significant multivariable predictors of hospital death were aortic calcifications, coexisting vasculopathy, and emergent procedure. Significant predictors of postoperative stroke were calcified or dilated aorta, and of prolonged hospital stay were advanced age, unstable angina, and coexisting vascular disease. For hospital survivors, 10-year actuarial late event-free rates were: death, 50%; myocardial infarction, 84%; stroke, 93%; percutaneous angioplasty, 95%; redo CABG, 98%; and all morbidity and mortality, 48%. Significant multivariable predictors of late deaths were coexisting vasculopathy, age, renal insufficiency, previous cardiac surgery, tobacco abuse, calcified or atheromatous aorta, and duration of intensive care unit stay. CONCLUSION: Concurrent CEA and CABG can be performed with acceptable operative mortality and morbidity, and good long-term freedom from coronary and neurologic events. Atheromatous aortic disease is a harbinger of poor operative and long-term outcome.