Resection of thymic carcinoma after induction therapy and reconstruction of right ventricular outflow tract with pulmonary homograft.

Treatment of malignant epithelial thymic tumours, including thymoma and thymic carcinoma, is based on surgical resection, whenever possible. Mainstay of surgical treatment is complete resection with clear margins. This may require resection of adjacent structures, even major vessels. We describe a case of resection of the main pulmonary artery trunk and reconstruction with cadaveric homograft after induction chemo-radiotherapy for a locally advanced thymic carcinoma. Written informed consent was obtained from the patient.

Twenty-year experience with skeletonized bilateral internal thoracic arteries for surgical myocardial revascularization. A single center experience.

BACKGROUND AND AIM OF THE STUDY: The mammary artery shows excellent long-term patency and encourages the use of skeletonized bilateral internal thoracic arteries (BITA) for coronary surgery. We analyzed the long-term outcome of patients operated for myocardial revascularization with BITA in a single center. MATERIALS AND METHODS: Clinical data and surgical details of patients undergoing coronary surgery with BITA were prospectively collected and retrospectively analyzed. Selected variables were studied as risk factors for sternal wound complication and a subanalysis of clinical outcome for patients aged 70 years or greater was performed. A long-term follow-up of the study group is provided. RESULTS: From January 2001 to November 2021, 750 patients underwent myocardial revascularization using BITA grafts (mean age: 61 ± 9.5 years; males: 91%) at our institute. Patients with triple-vessel disease were 81%, 15.3% of all procedures were performed off-pump and 3.6% were urgent cases. Hospital mortality was 0.5%. Sternal wound complication was observed in 67 patients (9.0%) with 7 deep sternal wound infections (0.9%). Female gender (odds ratios [OR]: 3.7, p < 0.01), BMI >30 (OR: 1.8, p = 0.04), smoking (OR: 1.8, p = 0.02), and chronic kidney failure (OR: 3.7, p = 0.05) were independent predictors for sternal complications. During a mean follow-up time of 8.7 ± 5.3 years, 34 patients (4.5%) underwent a repeated myocardial revascularization, and there were 89 all-cause deaths (11.9%) and the cumulative survival at 5, 10, 15, and 20 years was 97%, 89%, 76%, and 60% for the whole study group 92%, 74%, 47%, and 43% for the subgroup of elderly patients (mean age: 74 ± 3.5 years). CONCLUSIONS: Use of skeletonized bilateral thoracic arteries shows low-rate of wound infection and good long-term outcome with low risk of repeated revascularizations, regardless of patients' age.

Mitral valve replacement in pregnancy: a successful strategy for fetal survival.

The incidence of bacterial endocarditis (BE) during pregnancy is about 0.01%, while maternal and fetal mortality rates due to BE are 22% and 15%, respectively. Fetal survival is <15% until week 25 of gestation, and cesarean delivery is recommended before cardiopulmonary bypass in the third trimester. The case is described of a 24-year-old woman (a known drug addict), gravida 1, para 0, at week 22 of gestation, with an acute mitral valve endocarditis caused by Staphylococcus aureus. Following urgent mitral valve replacement, the strategy for fetal survival involved reducing the hemodilution and scavenging the cardioplegia solution from the right atrium, avoiding deep hypothermia to minimize rewarming, and maintaining a high pump flow rate (>2.5 l/min/m2) with a mean perfusion pressure of 70 mmHg, using pulsatile perfusion. The patient had an uneventful postoperative course, and at 34 weeks' gestation a normal newborn of 1780 g was delivered by cesarean section. No controlled clinical trials using extracorporeal circulation during pregnancy have been conducted, and reports are limited to single cases. A strategy was proposed to manage the present case of uncontrolled maternal BE at an early gestational age, by addressing several factors that would influence the outcome for both mother and baby.

Off-pump coronary artery bypass grafting without mechanical stabilization in minipericardiotomy.

Stabilization and exposure of coronary vessels in off-pump bypass grafting is achieved by means of different and expensive mechanical stabilizers. We describe a new technique of stabilization and exposure of target vessels by using only a 'double suspension-stabilization stitch' without the support of mechanical stabilizers. In accomplishing left anterior descending and right coronary artery off-pump bypass grafting, this technique has resulted in a good hemodynamic stability, in no epicardial damage and surgical trauma, and finally it represents a costless procedure.