Single coronary artery with aortic valve replacement followed by aortic root replacement due to endocarditis: A case report.

A woman with a single coronary artery underwent aortic valve replacement due to aortic stenosis. Two years later, she developed an aortic annular abscess around the right coronary cusp and non-coronary cusp. Significant adhesions to the right coronary artery (RCA) resulted from the abscess, making artery separation challenging, and raising concerns about potential future RCA stenosis. The patient subsequently underwent aortic root replacement and coronary artery bypass grafting. Utilizing a freestyle valve and a saphenous vein graft for the RCA. Following the procedure, the patient was discharged and has remained symptom-free without any recurrence of infection for 2 years.

A Comparative Prospective Observational Study on the Use of Direct Oral Anticoagulants after Cardiac Surgery for the Management of Atrial Fibrillation.

PURPOSE: Recently, guidelines recommended the use of direct oral anticoagulants (DOACs) for the management of non-valvular atrial fibrillation (NVAF). Postoperative atrial fibrillation (POAF) is the most common post-surgical complication of cardiac surgery, but the efficacy and safety of DOAC for POAF have rarely been investigated. We conducted a prospective observational study to investigate the efficacy and safety of DOAC administered immediately after POAF. MATERIALS AND METHODS: In all, 135 patients that experienced POAF after cardiac surgery were treated with a DOAC. Primary endpoints were either bleeding or thromboembolic events. Secondary endpoints included changes in hemoglobin (Hb), prothrombin time (PT), activated partial thromboplastin time (APTT), serum creatinine (sCr), estimated glomerular filtration rate (eGFR), and pleural/pericardial effusion. RESULTS: Patients were treated with apixaban (n = 31), edoxaban (n = 87), and rivaroxaban (n = 17). Major bleeding (p = 0.011) and gastrointestinal (GI) bleeding (p = 0.047) were significantly more frequent in the rivaroxaban group. Stroke was observed in one rivaroxaban group patient and none in the other two groups. CONCLUSION: DOAC as anticoagulation therapy for the early intervention of POAF following cardiac surgery is associated with a low incidence of major bleeding; a favorable safety profile and excellent efficacy were demonstrated for DOAC. Furthermore, our results indicate that the safety and efficacy of apixaban and edoxaban are better than rivaroxaban.

New Treatment for Driveline Infection Following Implantation of a Ventricular Assist Device.

In patients with an implantable ventricular assist device (VAD), driveline infection (DLI) is a challenging complication. Once DLI occurs, it may lead to pump contamination and/or septicemia, which means that early treatment is essential. We hereby report our initial experiences of a mechanically-powered portable negative pressure wound therapy system (Smart Negative Pressure: SNaPTM) to treat DLI at an outpatient clinic.

Is malnutrition associated with postoperative complications after cardiac surgery?

BACKGROUND AND AIM: Malnutrition is the central component of frailty that has an adverse influence on the prognosis of patients undergoing cardiac surgery. The relationship between malnutrition and postoperative complications was evaluated in a retrospective cohort study. METHODS: In 287 patients undergoing elective cardiac surgery, nutritional status was assessed by using the Geriatric Nutritional Risk Index (GNRI). Then the patients were divided into a malnutrition group (GNRI <91) and a nonmalnutrition group (GNRI ≥91), after which the postoperative course was compared. RESULTS: There were 51 patients (17.8%) in the malnutrition group. Nine patients died after surgery and the operative mortality rate was significantly higher in the malnutrition group than the nonmalnutrition group (five deaths [9.8%] vs four deaths [1.8%]; P = .003). In addition, the duration of intensive care unit stay and hospital stay were both significantly longer in the malnutrition group compared with the nonmalnutrition group. Multivariate analysis showed that malnutrition was an independent predictor of hospitalization for longer than 1 month (odds ratio [OR]: 3.428; 95% confidence interval [CI]:1.687-6.964; P = .001) and a postoperative bedridden state (OR: 7.377; 95% CI:1.874-29.041; P = .004). CONCLUSIONS: Preoperative evaluation of the nutritional status using the GNRI seems to be valuable for predicting the risk of postoperative complications.

Surgical treatment for double-chambered right ventricle in a septuagenarian.

The majority of patients with double-chambered right ventricle present during childhood; it is rarely treated in adults. We report the case of a 71-year-old woman who presented with mild fatigue for 2 years. Investigation of an ejection systolic murmur revealed a double-chambered right ventricle with a peak gradient of 147 mm Hg across the right ventricular outflow tract. Substantial right ventricular muscle bundle resection and augmentation of the right ventricular outflow tract with a bovine pericardial patch were performed after a right ventriculotomy.