Atrial approaches in mitral valve surgery: a propensity analysis of differences in the incidence of clinically relevant adverse effects.

BACKGROUND: The lack of evidence on complications using mitral valve approaches leaves the choice of risk exposure to the surgeon's preference, based on individual experience, speed, ease, and quality of exposure. METHODS: The present study analysed patients undergoing mitral valve surgery using a superior transseptal approach or a left-atrial approach between 2006 and 2018. We included first-time elective mitral valve procedures, isolated, or combined, without a history of rhythm disturbances. We used propensity score matching based on 26 perioperative variables. The primary endpoint was the association between the superior transeptal approach and clinically significant adverse outcomes, including arrhythmias, need for a permanent pacemaker, cerebrovascular events, and mortality. RESULTS: A total of 652 patients met the inclusion criteria; 391 received the left atrial approach, and 261 received the superior transseptal approach. After matching, 96 patients were compared with 69 patients, respectively. The distribution of the preoperative and perioperative variables was similar. There was no difference in the incidence of supraventricular tachyarrhythmias or the need for treatment. The incidence of nodal rhythm (p = 0.008) and length of stay in intensive care (p = 0.04) were higher in the superior transseptal group, but the need for permanent pacemaker implantation was the same. Likewise, there was no difference in the need for anticoagulation due to arrhythmia, the incidence of cerebrovascular events or mortality in the postoperative period or in the long-term follow-up. CONCLUSION: We did not find an association with permanent heart rhythm disorders or any other significant adverse clinical outcome. Therefore, the superior transeptal approach is useful and safe for mitral valve exposure.

Brachiocephalic Vein and Superior Vena Cava Reconstruction with a Superficial Femoral Vein Graft

Abstract Superior vena cava syndrome (SVCS) is an entity that has become more frequent due to the increasing use of indwelling central venous catheters. Surgical management is considered in patients with extensive venous thrombosis and when endovascular therapy is not feasible. The use of superficial femoral vein is an excellent technique for reconstruction of the brachiocephalic vein and superior vena cava (SVC) in cases with benign and malignant etiologies. We describe two cases of SVCS that were managed surgically at our institution with replacement of the SVC and brachiocephalic veins with a superficial femoral vein graft technique.

Brachiocephalic Vein and Superior Vena Cava Reconstruction with a Superficial Femoral Vein Graft.

Superior vena cava syndrome (SVCS) is an entity that has become more frequent due to the increasing use of indwelling central venous catheters. Surgical management is considered in patients with extensive venous thrombosis and when endovascular therapy is not feasible. The use of superficial femoral vein is an excellent technique for reconstruction of the brachiocephalic vein and superior vena cava (SVC) in cases with benign and malignant etiologies. We describe two cases of SVCS that were managed surgically at our institution with replacement of the SVC and brachiocephalic veins with a superficial femoral vein graft technique.

Fibroelastoma papilar incidental o sintomático ¿Debeintervenirse? / Incidental or symptomatic papillary fibroelastoma: Should it be treated?

Resumen El fibroelastoma papilar, también conocido como papiloma fibroelástico, es un tumor benigno poco común, que se puede observar en las válvulas cardíacas o, en algunas ocasiones, en el endocardio ventricular. Se describen dos casos; el primero corresponde a un paciente de 72 años con fibrilación auricular paroxística, asintomático por lo demás, en quien en estudio de su fibrilación auricular se evidenció masa pediculada de 1 y 1 cm dependiente de la válvula pulmonar y por riesgo de embolia se llevó a cirugía en la que se resecó masa, sin complicaciones. El reporte de histopatología fue positivo para fibroelastoma papilar. El segundo caso es una paciente de 67 años, sintomática, con angina de esfuerzo en quien, mediante ecocardiograma transtorácico, se documentó masa de 1,5 y 1,5 cm dependiente de la valva coronariana derecha, se consideraron síntomas secundarios a la masa. Se llevó a cirugía por técnica mínimamente invasiva y se resecó la masa. El reporte de histopatología fue positivo para fibroelastoma papilar. Conclusión: el fibroelastoma papilar es una causa poco frecuente pero cada vez más reconocida de fenómenos embólicos. Su identificación oportuna permite la extirpación de la lesión, que es aparentemente curativa, segura y bien tolerada.

Abstract The papillary fibroelastoma, also known as fibroelastic papilloma, is a fairly uncommon benign tumour that can be found in cardiac valves or, in some occasions in the ventricular endocardium. Two cases are presented, with the first corresponding to a 72 year-old patient with intermittent atrial fibrillation, with no other symptoms. During the study of the atrial fibrillation, a pedunculated mass of 1 × 1 cm was observed hanging from the pulmonary valve. Due to the risk of emboli, the patient was taken to surgery where the mass was resected with no complications. The histopathology reported positive for a papillary fibroelastoma. The second case was a 67 year-old patient with symptoms of with angina of effort, which on observing a mass of 1.5 × 1.5 cm hanging from the right coronary valve, they were considered as symptoms secondary induced by the mass. He was taken to surgery, and the mass was resected using a minimally invasive technique. The histopathology reported positive for a papillary fibroelastoma. Conclusion: Papillary fibroelastoma is a rare cause, but increasingly recognised due to its embolic phenomena. Their timely identification allows the lesion to be extirpated, which is apparently curative, safe and well tolerated.