Oxygen delivery monitoring under cardiopulmonary bypass : what implication on postoperative morbidity and mortality ?

INTRODUCTION: The standard control parameters of cardiopulmonary bypass (CPB) currently used in Tunisia are replaced in Western countries by the concept of "goal-directed-perfusion" requiring oxygen delivery (DO2) minimum at 270ml / min / m2. AIM: In this study, we explored the association between the DO2 and the postoperative morbidity and mortality. METHODS: This is a cross-sectional and retrospective observational study including a series of 50 patients operated on for myocardial revascularization under CPB. RESULTS: We noticed a significant correlation between starting DO2i and Creatinine clearance at day 0, Δcreate (day 1-day 0) and ventilation time. There was also a significant correlation between discharge DO2i and daytime urine output, ventilation time, hospital stay and in-hospital mortality. Through a univariable study, we compared the classic parameters of perfusion monitoring during CPB in addition to the starting DO2i with the different postoperative results. It was noted that the starting DO2i figures below the threshold of 270ml / min / m² were significantly correlated with the duration of administration of catecholamines postoperatively, with prolonged ventilation, with the variation in serum creatinine postoperatively and with in-hospital mortality. CONCLUSION: DO2 is a monitoring tool that has proven its advantages for monitoring under CPB.

Surgical management of a simultaneous aortic valve replacement and pneumonectomy.

Combined heart surgery and lung resection remains a controversial issue. The treatment of two major conditions in the same operative time may be attempted in certain cases. We report the case of a 68-year-old man who presented for dyspnea on exertion. The chest computerized tomography scan showed an infiltrating tumor which involved the right interlobar artery. A pneumonectomy was indicated and the preoperative echocardiography detected a calcified aortic valve with severe stenosis and significant pressure gradient. The patient had combined pneumonectomy and aortic valve replacement through median sternotomy and was discharged 18 days after surgery. Cardiac valve replacement is feasible in conjunction with pulmonary resection. However morbidity is increased in case of associated pneumonectomy.

Adolescent coarctation of aorta treated with subclavian-descending aorta bypass grafting.

BACKGROUND: Aortic coarctation in older children most frequently represents cases of re-coarctation following previous transcatheter or surgical therapy or missed cases of native coarctation. METHODS: We describe three cases of adolescents ­ two girls and one boy ­ with aortic coarctation, operated between January, 2012 and December, 2013. Computed tomography angiography was performed as an essential diagnostic procedure. RESULTS: Hypertension was detected, and weaker arterial pulses in the lower limbs were noted in all cases. All operations were performed via left posterolateral thoracotomy. Aortic coarctation was treated surgically, with left subclavian-lower descending thoracic aorta bypass grafting. Postoperative course was uneventful in all cases. No residual brachial-ankle pressure gradient was observed, and all patients have remained in good condition after the operation. CONCLUSIONS: Surgical treatment of aortic coarctation in adolescent patients can be achieved by resection with end-to-end anastomosis, interposition of a graft or bypass graft across the area of coarctation when the distance to be bridged is too long for end-to-end repair. The extra-anatomic subclavian-descending aortic bypass grafting provides good results in adolescent patients, particularly in those with complex coarctation.