ABSTRACT
Percutaneous transaxillary approach (PTAX) through the first segment of the axillary artery is not widely recognized as a safe method. Furthermore, PTAX has never been directly compared between Impella-supported percutaneous coronary interventions (Impella-PCI) and transcatheter aortic valve replacement (TAVR). This study evaluated the feasibility and safety of PTAX through the first axillary segment in Impella-PCI versus TAVR. In cases where standard imaging guidance was insufficient, a technique involving puncturing the axillary artery "on-the-balloon" was employed. The endpoints were bleeding and vascular complications, as defined by BARC and VARC-3 criteria. PTAX was successfully performed in all 46 attempted cases: 23 for Impella-PCI and 23 for TAVR. Strict adherence to BARC and VARC-3 criteria led to the frequent identification of major bleeding (57%) and a moderately frequent diagnosis of vascular complications (17%). These incidences were primarily based on post-procedural hemoglobin reduction (> 3 g/dl) but not overt bleeding. The Impella group exhibited a higher rate of BARC 3b bleeding due to a greater hemoglobin decline resulting from the prolonged implant duration and PCI itself. Left axillary access was linked to smaller blood loss. Bleeding and vascular complications, as per BARC and VARC-3 definitions, did not affect short-term prognosis, with only 3 Impella patients succumbing to heart failure unrelated to the procedures during one-month follow-up period.
Subject(s)
Percutaneous Coronary Intervention , Transcatheter Aortic Valve Replacement , Humans , Axillary Artery/surgery , Transcatheter Aortic Valve Replacement/adverse effects , Percutaneous Coronary Intervention/adverse effects , Axilla , HemoglobinsABSTRACT
INTRODUCTION: Cardiac surgery and cardiac interventions are associated with the risk of iatrogenic complications, including hemothorax. Minimally invasive methods of evacuating hemothorax include video-assisted thoracic surgery (VATS). AIM: This paper presents this method and provides its detailed analysis. MATERIAL AND METHODS: The VATS procedures were used to evacuate hemothorax in 8 patients (7 after cardiac surgery and 1 after a cardiac intervention). Complete three-port VATS was performed in 7 patients, while 1 patient underwent assisted VATS due to a large number of adhesions. RESULTS: On average, the repeat procedures were performed on the 20th postoperative day (10th-58th postoperative day). In 6 (75%) cases the VATS intervention was the third surgical intervention performed. One patient, operated on 12 days after the original procedure, was diagnosed with active arterial bleeding, which required conversion to a classic procedure using median sternotomy. No postoperative wound infection was noted. Complete hemothorax removal was achieved in all patients. CONCLUSIONS: Classic median sternotomy is the standard approach for hemothorax evacuation. However, it may sometimes be burdened with a high perioperative risk due to massive mediastinal adhesions in the late postoperative period. Additionally, access through the postoperative wound appears to be associated with a higher risk of local infection and sternal instability. Hemodynamically stable patients in the late postoperative period, with stable sternums and healed postoperative wounds, are good candidates for VATS aiming to evacuate hemothorax. The VATS is an effective procedure for evacuating hemothorax.
ABSTRACT
BACKGROUND: As arterial myocardial revascularization is proved to provide great results, radial artery use as a graft and its consequences remain an important issue. OBJECTIVES: The aim of the study was to evaluate how patients assess their forearm and hand function after radial artery harvest for coronary artery bypass grafting (CABG). METHODS: 50 patients (mean age 52.2 ± 7.4 years) who underwent CABG at least 6 months (median follow up 11.75 months) earlier filled in a questionnaire concerning hand and forearm efficiency and discomfort. RESULTS: The global efficiency of the operated upper extremity was scored mean 8.87 ± 1.26 points on a 10-point scale and it was worse in patients who noticed at least one sort of disorder than in patients with no problems (8.6 ± 1.4 versus 9.4 ± 0.7 points; P = .04). Paresthesias were the most often reported disorders; 21 patients felt some tingling and/or numbness, but in only 14 (28%) could the symptoms be considered as related to the operation. 20 patients (40%) declared that they felt some scar-related discomfort. Reduced grip strength and excessive hand fatigue were reported by 20% and 10% of patients, respectively. None of those interviewed answered that symptoms reported affected his or her life activity on any level. CONCLUSION: The hand and forearm efficiency after radial artery harvest for CABG was highly evaluated by the majority of patients. Despite the fact that many patients reported some surgery-related problems, they did not notice extremity dysfunction that could limit their life activity.
Subject(s)
Coronary Artery Bypass/methods , Coronary Artery Disease/surgery , Forearm/physiology , Hand/physiology , Postoperative Complications , Radial Artery/transplantation , Risk Assessment/methods , Tissue and Organ Harvesting/methods , Adult , Aged , Female , Follow-Up Studies , Forearm/blood supply , Hand/blood supply , Humans , Male , Middle Aged , Risk Factors , Surveys and QuestionnairesABSTRACT
We report a case of an eleven-year-old boy operated because of a tumour in the left ventricle. Surgery was successful and histological examination revealed angiofibromyxoma. The follow-up was uneventful. We present this case because of the unusual tumour localisation.
Subject(s)
Heart Neoplasms/diagnosis , Heart Neoplasms/surgery , Heart Ventricles/surgery , Myxoma/diagnosis , Myxoma/surgery , Child , Echocardiography , Humans , MaleABSTRACT
We describe a case of 65-year-old woman with unstable angina, who was admitted to our institution. Physical examination revealed the presence of a systolic cardiac murmur. Transthoracic echocardiography showed subvalvular aortic stenosis. The patient underwent successful coronary artery by-pass surgery and myectomy surgery. Diagnosis and treatment of subvalvular stenosis coexistent with coronary artery disease are discussed.
Subject(s)
Angina, Unstable/complications , Aortic Stenosis, Subvalvular/complications , Aged , Angina, Unstable/surgery , Aortic Stenosis, Subvalvular/surgery , Coronary Artery Bypass/methods , Female , HumansABSTRACT
We present a case of a 49-year-old patient with cardiac tamponade due to haemopericardium. The decision to perform surgery, although controversial, allowed to diagnose cardiac angiosarcoma with metastases to pericardium, vena cava superior and pulmonary trunk. Consequently, chemotherapy was instituted and was initially effective, however, the patient died 12 months later due to the progression of the disease.
