Traction suture modification of the Cosgrove hemisternotomy technique.

BACKGROUND AND AIM OF THE STUDY: Minimal access is an integral part of cardiac surgery. A personal customization is presented of the Cosgrove technique of hemisternotomy for aortic valve surgery. METHODS: The procedure involves an additional 2 cm right anterior intercostal incision, through which a Roberts clamp is used to tension a suture from the right pericardial flap, thus optimizing exposure of the right atrium. The incision is used later to insert a pericardial drain. RESULTS: The modified Cosgrove technique was applied to 66 patients (43 men, 23 women; mean age 60.47 years; median age 64 years; range: 29-85 years) between January 2005 and March 2010. During the postoperative period, no conversion, tamponade or fatality has been observed among patients. CONCLUSION: This traction suture represents a simple and safe means of optimizing exposure of the right atrium, which is problematic in this type of operation.

Pulmonary embolism following coronary artery bypass grafting.

BACKGROUND: Pulmonary embolism (PE) is a life-threatening complication, with a deceptive clinical presentation following coronary artery bypass grafting (CABG). METHODS: We identified 13 studies on PE in post-CABG patients, spanning a period of 34 years. RESULTS: The overall cumulative incidence of PE following CABG was 1.3% (111 PEs in 8553 CABGs). CONCLUSION: We suggest further prospective randomized studies to examine the effect of saphenous system vein grafting, and choice of low molecular weight heparin prophylaxis on the incidence of post-CABG PE.

Translating Chagasic dilating cardiomyopathy to surgical therapies: An under published global challenge.

Chagas disease is a neglected parasitic anthropozoonosis of the Americas linked to social deprivation with no hope of eradication in the future. Having been the most common non-ischemic cause of dilating cardiomyopathy in Latin America, it now spreads beyond the geographical boundaries of its vector via imported and autochthonous transmission. We review the evidence on surgery in Chagasic heart failure and offer a brief narrative on the main aspects of translational management. There is very limited literature on surgery for Chagasic heart failure, especially assist devices and transplantation. This may be attributed to the often unsurmountable economic burden of this single-system parasymphatholytic heart failure to young sufferers who commonly have very limited access to the aforementioned procedures. Chagasic heart failure offers a so far neglected translational model of parasymphatholytic non-ischemic cardiac failure.

Tropical diseases of the myocardium: a review.

Cardiovascular diseases are widely distributed throughout the world. Human parasitic infections are ubiquitous. Tropical parasites are increasingly recognized as causes of cardiovascular diseases. In this review, we address the most frequently reported parasites that directly infect the myocardium, including Trypanosoma cruzi, the protozoal causative agent of American trypanosomiasis (Chagas disease), and Taenia solium, the cestode causative agent of taeniasis and cysticercosis. We also discuss tropical endomyocardial fibrosis, trichinellosis and schistosomiasis. Health systems, attitudes, the perceptions of both patients and physicians as well as socioeconomic factors should all be explored and recognized as crucial factors for improving the control of cardiovascular diseases in the tropics. Clinicians throughout the world must remain aware of imported parasites as potential causes of cardiac diseases.

Does Body Mass Index Affect Mortality in Coronary Surgery?

INTRODUCTION: The Body Mass Index (BMI) quantifies nutritional status and classifies humans as underweight, of normal weight, overweight, mildly obese, moderately obese or morbidly obese. Obesity is the excessive accumulation of fat, defined as BMI higher than 30 kg/m2. Obesity is widely accepted to complicate anaesthesia and surgery, being a risk factor for mediastinitis after coronary artery bypass grafting (CABG). We sought the evidence on operative mortality of CABG between standard BMI groups. MATERIALS AND METHODOLOGY: A simple literature review of papers presenting the mortality of CABG by BMI group: Underweight (BMI ≤ 18.49 kg/m2), normal weight (BMI 18.5-24.9 kg/m2), overweight (BMI 25.0-29.9 kg/m2), mild obesity (BMI 30.0-34.9 kg/m2), moderate obesity (BMI 35.0-39.9 kg/m2), or morbid obesity (BMI ≥ 40.0 kg/m2). RESULTS: We identified 18 relevant studies with 1,027,711 patients in total. Their variability in size of samples and choice of BMI groups precluded us from attempting inferential statistics. The overall cumulative mortality was 2.7%. Underweight patients had by far the highest mortality (6.6%). Overweight patients had the lowest group mortality (2.1%). The group mortality for morbidly obese patients was 3.44%. DISCUSSION: Patients with extreme BMI's undergoing CABG (underweight ones more than morbidly obese) suffer increased crude mortality. This simple observation indicates that under nutrition and morbid obesity need be further explored as risk factors for coronary surgery.

Vocal cord palsy as a complication of adult cardiac surgery: surgical correlations and analysis.

Vocal cord palsy after adult cardiac surgery is often attributed to non-surgical mechanisms as tracheal intubation and central venous catheterisation. It may also be caused by injury of the recurrent laryngeal nerves by surgical dissection. We hereby present a review of relevant clinical reports. The cumulative incidence was 1.1% (33 in 2980). Main reported surgical mechanisms of injury were harvesting of internal thoracic artery and topical cold cardioprotection. Bilateral nerve palsy has been lethal on at least one occasion. Where vocal cord injury followed harvesting of the left internal thoracic artery, it was reported ipsilateral to the conduit.

Evolving dimensions in medical case reporting.

Medical case reports (MCRs) have been undervalued in the literature to date. It seems that while case series emphasize what is probable, case reports describe what is possible and what can go wrong. MCRs transfer medical knowledge and act as educational tools. We outline evolving aspects of the MCR in current practice.

The natural bifurcating internal thoracic artery graft: another technique for bypassing two vessels with one conduit.

We present our reproducible technique of achieving two bypasses from selected pedicled internal thoracic arteries. We feel that awareness of this technical modification is to the benefit of patients.