Determinant of outcome in late presenting type A aortic dissection.

BACKGROUND: Early repair is recommended in type A aortic dissection repair, however, this is not often possible. The aim of this study was to assess the time delays, examine the effect of timing and malperfusion on outcomes, and identify other independent risk factors for mortality. METHODS: This was a retrospective study on data collected prospectively. Primary outcome was 30-day mortality. Secondary outcome was adverse postoperative outcomes. All patients who arrived at the hospital with a type A aortic dissection, irrespective of the timing, were included in the study. Univariate as well as multivariate analysis was carried out. RESULTS: A total of 81 patients presented to our institution during the study period. Half the patients got operated within 86 h of symptom onset and 75% were operated within 183 h. With regards to malperfusion, 6 (8.8%) patients had cerebral malperfusion, 10 (14.7%) had features of myocardial ischemia, and 13 (19.1%) had renal malperfusion. One (1.5%) patient had mesenteric ischemia and 9 (13.2%) had limb ischemia. The duration between symptom onset and operative repair was longer in survivors (152 ± 167 vs. 75 ± 102, p = .29). A total of 29 (42.6%) patients presented with features of one or more organ malperfusion and the mortality in these patients was significantly higher at 10 (34.5%) versus 5 (12.5%); p = .04. Multivariable logistic regression identified CPB time as an independent risk factor in our cohort for 30-day mortality (odds ratio: 1.03; 95% confidence interval: 1.007-1.06). CONCLUSION: In cases of predominantly delayed presentation and operative repair, the outcome is significantly influenced by presence of malperfusion. Surgical repair still produces satisfactory outcomes and should be undertaken at the earliest in most cases.

Oversized donor heart transplantation-clinical experience with an underestimated problem.

PURPOSE: Heart transplantation is the definitive treatment for end-stage heart failure. With respect to donor-recipient size matching, the problems with undersized heart transplantation have been widely discussed, but there is a paucity of information on oversized transplants due to the presumed advantage of large hearts. We intend to share our center's experience with oversized heart transplantation and its associated problems which would help to expand the knowledge on oversized cardiac allografts. METHODS: Patients who underwent isolated heart transplantation at our hospital between March 1, 2008, and March 1, 2020, were included. For adults, a donor-recipient predicted heart mass percentage difference exceeding 30% and for children, a donor-recipient weight ratio < 0.8 and > 2.0 was considered a mismatch. We collected data from the in-patient medical records and analyzed the in-hospital outcomes and survival post-transplant among various other parameters. RESULTS: Out of the 43 patients included in this study, 32 (74.4%) patients received a matched heart and 11 (25.6%) patients received oversized hearts. None of the patients received an undersized heart. The in-hospital mortality rate of oversized transplants was 18.2% whereas that of matched transplants was 9.4% (p = 0.432). The post-operative characteristics and 1-year survival were comparable between the groups. We encountered problems specific to oversizing in 5 of the 11 patients (45.4%) which are discussed. CONCLUSION: With the liberalization of donor criteria to overcome organ shortage, oversized heart transplantation poses certain unique challenges, which when efficiently managed offers acceptable outcomes.

Surgical management of hydatid cyst of the interventricular septum.

Cardiac hydatidosis constitutes about 0.5-2% of all hydatid diseases. The interventricular septum is involved in 4% of cardiac hydatidosis cases. We demonstrate the surgical management of a large (76 x 66 mm) septal hydatid cyst in a 20-year-old man. The hydatid cyst was approached through a right ventriculotomy under cardiopulmonary bypass. The germinative membrane was removed in toto. The cavity was then obliterated to prevent recurrence of the cyst. The patient had an uneventful postoperative recovery. Histopathological examination confirmed the diagnosis of hydatid cyst. The patient remains asymptomatic with echocardiographic and magnetic resonance imaging evidence of freedom from disease at the 3-month follow-up.

Secure Closure of Right Ventricular Perforation Reinforced With Coronary Artery Wall.

Accidental entry into the right ventricular cavity is a common occurrence during exposure of the intra-myocardial left anterior descending artery. Several techniques have been described for repair of the perforation. Although these methods can be used, there is still a danger of persistent bleeding or distal ischemia. We describe a method that is safe and reproducible.