Early-Term Complications after Carotid Endarterectomy and Their Risk Factors: Eight-Year Employment of Local Treatment Protocol of a Russian High-Volume Center.

BACKGROUND: More than 20,000 carotid endarterectomies are performed annually in the Russian Federation. Until now, no studies based on the national carotid data set have been published. The objectives of this study were to evaluate early outcomes after carotid endarterectomy and to identify potential risk factors for major adverse cardiovascular events. MATERIALS AND METHODS: The retrospective analysis was based on data recorded in a single-center registry, including all carotid endarterectomies performed between 2010 and 2017. A univariate analysis was used to identify the risk factors for perioperative mortality, and predictors of stroke were determined using a multivariate logistic regression model. RESULTS: Data from 1,832 patients with a mean age of 64.1 ± 7.6 years were analyzed. The combined in-hospital mortality was 0.65% (12/1,832). The rate of stroke was 0.7% (13/1,832), and the rate of myocardial infarction was 1.1% (20/1,832). The 30-day stroke-free survival was 99%. A history of stroke (p = 0.02) and chronic obstructive pulmonary disease (COPD; p = 0.0001) were found to be predictive of a lethal stroke. Previous myocardial infarction (p = 0.0001), an advanced stage of congestive heart failure (p = 0.0001), and angina pectoris (p = 0.01) were associated with cardiac-related mortality. Moreover, diabetes mellitus (p = 0.03), COPD (p = 0.0001), and carotid calcinosis (p = 0.006) increased the risk of poor survival due to myocardial infarction. The mean duration of clamping was found to be an independent predictor of any perioperative stroke (OR = 1.109; 95% CI 1.052-1.129; p < 0.0001). CONCLUSIONS: The present retrospective analysis of the local carotid surgery register showed appropriate outcomes after CEA regarding the cumulative incidence of MACE, which is comparable to previously published international register data. A previous history of stroke, myocardial infarction, COPD, a prolonged clamping time during CEA, and diabetes mellitus were found to be factors of high-risk for cardiovascular mortality. A prolonged clamping was identified as an independent predictor of any stroke.

The outcome of acute occlusion of the abdominal aorta with bilateral limb ischaemia.

Background: The purpose of this study was to investigate if the duration of bilateral acute limb ischaemia (BALI) caused by acute aortic occlusion (AAO) affected amputation-free survival. Materials and methods: A retrospective analysis of patients treated between 1 January 2010 and 1 January 2019 for primary occlusion of the infrarenal aorta and BALI was performed. Univariate analysis was used to determine the risk factors for adverse outcomes and compare the duration of BALI between the amputation-free survival and non-amputation-free survival groups. Results: The data from 16 patients with a mean age of 70 ± 11 years were analysed. Predominantly females (56.3%, 9/16) were included in the study. Out of 16 patients, nine had Rutherford grade IIb, and seven had Rutherford grade III at admission. Seven patients underwent revascularisation attempts, two underwent primary major amputation, and seven underwent primary palliation. The mean ischaemia time was significantly shorter in the amputation-free survival group than in the non-amputation-free survival group (7.4 ± 3.5 h vs 22.4 ± 16.3 h, p = .01). The time frame for successful bilateral lower limb revascularisation was <11 h (p = .03). Conclusions: The duration of BALI due to AAO of <11 h was shown to be associated with improved amputation-free survival.

Surgical Treatment of Acute Type A Aortic Dissection with 18-Litre Bleeding.

Surgical treatment of Type-A acute aortic dissection is associated with high mortality and morbidity. One of the reasons is perioperative bleeding, which may lead to worse outcomes. We present a case of successful treatment of a patient with 18-litre perioperative blood loss in DeBakey Type-I acute aortic dissection with drug-induced hypocoagulation and malperfusion of a lower extremity.

Total full-thickness skin grafting for treating patients with extensive facial burn injury: A 10-year experience.

INTRODUCTION: Facial burns are not only a severe burn injury, but result in psychological disturbance. The improvement of the methods of treating facial burns remains topical. The aim of the study was to evaluate the effectiveness of approach based on full-thickness skin autografting for facial burn injuries. METHODS: During 2000-2019, ninety seven patients with the facial burn were treated in Burn Center. All patient were divided into two groups. The comparative analysis between groups was done. RESULTS: Group A was treated with full-thickness skin grafts (42 patients - 43.3%). Since 2010, total full-thickness skin graft was used in 11 patients from Group A. In group B, 55 patients (56.7%) were treated with split-thickness skin grafts, including 9 patients (16.4%) with total split-thickness skin graft transplantation. Total full-thickness skin graft was performed in case of a deep and extensive facial burn and cicatricial deformities. During the long-term period, a positive cosmetic result and the absence of indications for reconstructive operations were noted. CONCLUSION: The approach of facial burn treatment based on total full-thickness skin graft allows conditions for engraftment and adaptation of autograft, reduces the risk of scar developing and achieves maximum cosmetic results of treatment.

A New Approach and Old Techniques: Combined Endoscopic Repair of Inguinoscrotal Hernias.

BACKGROUND: The treatment of inguinoscrotal hernias (ISH) represents one of the most challenging areas in surgical pathology. Although these hernias could be repaired through a minimally invasive approach, open repair is still considered to be the technique of choice for most surgeons. The purpose of this study is to evaluate our new combined [open+transabdominal preperitoneal (TAPP)/total preperitoneal (TEP)] method of ISH repair. PATIENTS AND METHODS: The authors reviewed the charts of 124 patients with ISH who underwent hernia repair in different modifications: open, TAPP, TEP, and new combined method with a minimal follow-up of 3 months. RESULTS: New combined (open+TAPP/TEP) method repair was successful in all 38 patients. Average case duration was 68.8 minutes (62 to 106 min). No recurrence was observed for the 13 months follow-up. Two patients had intraoperative serosal bowel injury, 1 patient developed postoperative seroma, and 2 patients developed several pain. CONCLUSIONS: Combined (open+TAPP/TEP) method for ISH repair allows to minimize surgical trauma and reduce both the procedure time and the postoperative length of stay. Implementation of this method results in statistically significantly fewer wound-related postoperative complications compared with traditional methods.

Upper ministernotomy for mitral valve replacement via superior approach.

This video tutorial demonstrates the surgical technique for mitral valve replacement through the roof of the left atrium via an upper inverted T-shaped ministernotomy, with central cannulation for cardiopulmonary bypass.

Sampling or node dissection for intraoperative staging of lung cancer: a multicentric cross-sectional study.

OBJECTIVE: This study compares accuracy of sampling versus formal node dissection in patients with primary lung cancer. PATIENTS AND METHODS: During a 4-month period, 208 consecutive patients (172 men, 36 women) without bulky disease underwent resection for primary lung cancer in three centers. The surgeon first sampled the main lymph node stations, and subsequently performed a radical mediastinal dissection. Endpoints were accuracy of prediction for stage N2 and radicality of node sampling compared to dissection. RESULTS: Resection consisted of 1 segmentectomy, 142 standard lobectomies, 6 bilobectomies, 14 sleeve-lobectomies, and 45 pneumonectomies. There were 108 squamous cell carcinomas, 621 adenocarcinomas, 18 bronchoalveolar carcinomas, 8 large cell carcinomas, 4 adenosquamous carcinomas and 8 neuroendocrine carcinomas. Primary tumor was stage T1 in 49 patients, T2 in 110, T3 in 43, and T4 in 6. Lymph node status (dissection) was N0 in 113, N1 in 35, and N2 in 60 patients. N2 disease concerned a single node in 16, a single node station in 19, and multiple levels in 25. Both N1 and N2 nodes were diseased in 36 patients. Sampling adequately recognized N2 disease in 31 patients (52%). Multiple level N2 was accurately identified in 10 patients (40%). Resection based on sampling would have been incomplete in 53 patients (88%). CONCLUSION: Radical mediastinal dissection is a mandatory adjunct to resection for lung cancer with curative attempt.

Indications and results of sleeve carinal resection.

OBJECTIVE: Carinal resection is the most complicated procedure in tracheobronchial surgery. The main aspects of the technique are still debated at the present time. We present our experience of 231 carinal resections with analysis of operative techniques, complications and long-term survival. METHODS: Since 1979 we have performed 231 carinal resections. Indications for surgery included lung cancer in 151 cases (65.4%), non-bronchogenic carcinoma in 45 (19.4%), main bronchus fistula with short stump in 25 (10.8%), stenosis of tuberculous and nonspecific etiology in nine (4%), and trauma in one case (0.4%). We have performed 156 right-sided resections (67.5%) and 75 left-sided (32.5%). In 162 cases carinal pneumonectomy was undertaken, carinal resection following pneumonectomy was performed in 28 cases, isolated resection of bronchial bifurcation was performed in 25 cases, and in 15 cases we combined lobectomy and resection of bifurcation. The length of resection extended from one to nine tracheal rings. The operative approach was lateral thoracotomy in 102 cases (44.2%), and sternotomy in 129 (55.8%). RESULTS: Thirty-seven patients died postoperatively (16%). Complications were observed in 82 patients (35.4%), dominated by anastomotic problems which occurred in 58 cases (25.1%). The most frequent causes of death were respiratory distress syndrome and anastomotic dehiscence (P < 0.05). Mortality and the incidence of complications were significantly correlated to length of resection, laryngeal nerves injury, and mode of intraoperative ventilation. CONCLUSIONS: The feasibility of carinal resection is limited by the patient's functional status and extension of tumor growth. Thorough selection of patients may improve immediate and long-term results.

A Novel Tool to Facilitate Crimping Suture Placement for a Modified David V/Miller Aortic Root Replacement.

Surgical treatment of aortic root and ascending aorta aneurysms with aortic insufficiency is still controversial. A valve-sparing operation is the procedure of choice for such patients, and the reimplantation technique is preferable. We describe a simple technique for aortic root reconstruction that has been successfully performed for patients with aneurysms of aortic root and ascending aorta with aortic insufficiency.

A patient with giant left atrium undergoes orthotopic heart transplantation.

We present a novel technique for resolving the problem of radical size mismatch at the time of orthotopic transplantation. A 48-year-old man presented with chronic rheumatic heart disease and a giant left atrium. Twenty-three years before, he had undergone mitral valve replacement with a mechanical prosthesis. At the time of the repeated intervention, the volume of his left atrium was 350 mL. Surgical features of the transplantation included approximation of the pulmonary vein ostia by gathering sutures intentionally, in order to decrease the area of the left atrial posterior wall and thereby enable appropriate coaptation with the donor left atrium. After the operation, left atrial volume had been reduced to 60 mL.

A rare case of coronary artery bypass grafting in a patient with left ventricular noncompaction.

Ventricular myocardium noncompaction is a rare congenital cardiomyopathy resulting from an arrest in normal endomyocardial embryogenesis. Initially the noncompaction of the left ventricle was described in the pediatrics population with poor prognosis, but recent reports have noticed the presence of this pathology in the adult population. We describe a 54-year-old man with isolated noncompaction of the left ventricle who had ischemic heart disease and was successfully treated with bypass surgery.

First experience of cardiac autotransplantation for giant left atrium treatment.

Giant left atrium is a pathology that causes a lot of different complications, therefore it is very important to perform volume reduction. In some cases left atrium volume reaches a huge size. There are a lot of different methods for left atrium reduction: from wall plication, multicomponent resection followed by restoration integrity of wall to autotransplantation. In spite of the relative simplicity of plications and resection, these methods do not always allow to reduce left atrium to the desired volume. Cardiac autotransplantation is the most radical approach to the correction of giant left atrium which allows reducing left atrium including interatrial septum. The successful result of giant left atrium surgical treatment (volume of left atrium is 2200 ml according to the data of computerized tomography) by the method of autotransplantation is presented in the article.