Successful Heart Transplantation Without Blood Transfusion in a Jehovah's Witness Patient With Congenitally Corrected Transposition of the Great Arteries: A Case Report.

We report a case of heart transplantation in a 68-year-old Jehovah's Witness patient with congenitally corrected transposition of the great arteries (ccTGA) who developed heart failure due to right ventricular dysfunction. The patient underwent successful heart transplantation without the use of blood products, employing meticulous hemostasis and careful surgical planning. This case highlights the anatomical considerations and challenges in transplanting a heart in a patient with ccTGA, including the reversed positions of the pulmonary artery and the ascending aorta. It also emphasizes the importance of tailored surgical strategies to achieve hemostasis and avoid blood transfusion in Jehovah's Witness patients. This case adds to the limited literature on heart transplantation in patients with ccTGA and demonstrates that heart transplantation can be successfully performed without blood transfusion in Jehovah's Witness patients.

Redo Mitral Valve Replacement After Valve-in-Valve Transcatheter Mitral Valve Replacement.

The rising preference for percutaneous mitral valve-in-valve replacement (ViV TMVR) over redo surgical mitral valve replacement (MVR) is primarily due to its reduced bleeding risk. This report details a bloodless redo MVR performed for mitral stenosis post-ViV TMVR. We present detailed intraoperative findings, including images of the extracted bioprosthetic valves and cardiac anatomy, providing valuable insights into the surgical complexities encountered. The case underscores the importance of meticulous planning and execution in redo MVR, especially in patients with a history of multiple valve interventions. Additionally, this report discusses the potential complications associated with ViV TMVR, contributing to the evolving understanding of this procedure's long-term outcomes. Our findings highlight the need for careful consideration of patient-specific factors and the inherent risks of redo valve surgeries, aiming to improve patient outcomes in complex cardiac cases.

Successful Heart Transplantation With Myocardial Bridging: A Case Report on Unroofing Technique.

Myocardial bridging (MB), a common anatomical variation where a segment of a coronary artery is covered by myocardium, poses a relative contraindication in heart transplantation due to the risk of post-transplant ischemia. This report presents a case of successful transplantation of a donor heart with MB, where unroofing (removal) of the myocardial bridge was performed. The donor was a 42-year-old male with mild nonobstructive coronary artery stenosis and MB. The recipient, a 55-year-old male, suffered from ischemic cardiomyopathy and severe heart failure. During transplantation, unroofing of the donor heart's MB was executed to mitigate the risk of myocardial ischemia. The transplantation was successful with preserved postoperative cardiac function. The unroofing procedure did not significantly extend ischemic or operative time. Postoperative electrocardiogram (ECG) and echocardiography showed no signs of myocardial ischemia. Donor hearts with MB can be utilized for transplantation with appropriate surgical intervention. This case demonstrates the potential of unroofing procedures in expanding the suitability of donor hearts for transplantation, without increasing the risk of postoperative complications or mortality.

Challenges and Insights in Managing Device-Related Thrombosis Post-WATCHMAN Implantation: A Case Report of Surgical Thrombectomy in an Elderly Jehovah's Witness Patient With Atrial Fibrillation.

The WATCHMAN device offers a viable alternative to long-term oral anticoagulation for stroke prevention in nonvalvular atrial fibrillation, particularly for high-risk patients. Despite its success, device-related thrombosis (DRT) remains a concern, potentially restricting its wider use. We present an 83-year-old female Jehovah's Witness with atrial fibrillation who, after successful WATCHMAN device implantation, suffered multiple transient ischemic attacks six months later. Initial investigation revealed a thrombus on a slightly exposed strut of the almost completely endothelialized device. Despite treatment with warfarin and rivaroxaban, urgent surgical intervention was ultimately required to remove the thrombus completely. This case illustrates the risk of thrombus formation even with minimal strut exposure and the challenges in managing DRT. It also highlights the necessity for diligent monitoring and potential reassessment of post-implantation anticoagulation protocols. Our report adds to the limited literature regarding surgical thrombectomy following WATCHMAN implantation and provides valuable insights for clinicians managing similar scenarios.

Outcomes of isolated CABG from "OPCAB favor institution" for patients with left ventricular dysfunction.

OBJECTIVES: Although off-pump coronary artery bypass (OPCAB) has been reported to have better short-term results than on-pump coronary artery bypass (ONCAB) in terms of bleeding and stroke even in patients with cardiac dysfunction, details are unknown. The purpose of this study was to evaluate the outcomes of CABG (coronary artery bypass graft) in patients with low cardiac function based on our treatment policy. METHODS: Retrospectively, we reviewed patients with low ejection fraction (< 35%), who underwent isolated OPCAB or ONCAB between 2013 and 2020 in our institute. RESULTS: Isolated CABG was performed for 67 patients: 54 OPCABs and 13 ONCABs. In the ONCAB group, six were converted from OPCAB. Patients with AMI, heart failure, liver dysfunction, cardiogenic shock, and ventricular arrhythmia were more common in the ONCAB group. More patients required postoperative mechanical circulatory support in the ONCAB group. Intra-operative blood transfusion, ICU stay, intubation time, and hospital stay were significantly worse in the ONCAB group. Postoperative graft patency was 91.5%. Hospital mortality was 7.5%. Mid-term survival at 30-day, 1-year, and 5-year were 98.5%, 84.6%, and 75.8%, respectively. CONCLUSION: In our institute, ONCAB was selected for the patients who could not complete treatment with OPCAB due to poor preoperative circulatory status. Our treatment policy for the patients with impaired cardiac function was acceptable.

Survival After Cardiac Laceration From a Gunshot Wound: A Rare Case Report.

In the United States, approximately 48,000 deaths annually are attributed to gunshot wounds, with a notably low survival rate of 24.5% in cases involving cardiac injury. This case report presents a unique instance of a gunshot wound to the heart, where the patient, despite sustaining cardiac damage, maintained stable hemodynamics and underwent successful surgical removal of the bullet from the pericardial cavity. The absence of significant pericardial effusion and the maintenance of stable hemodynamics in this case provide valuable insights into the management of similar traumatic injuries. This report contributes to the existing knowledge on gunshot wound treatment, highlighting the importance of considering bullet retention in the pericardial cavity, even in the absence of substantial pericardial effusion.

Safety of retrograde cerebral perfusion under moderate hypothermia for hemiarch replacement.

OBJECTIVES: Aortic surgeries performed under moderate hypothermia require antegrade cerebral perfusion. The influence of retrograde cerebral perfusion under moderate hypothermic circulatory arrest remains unknown. To clarify this effect, this study aimed to compare the early outcomes of retrograde versus antegrade cerebral perfusion under moderate hypothermia for hemiarch replacement. METHODS: Between March 2009 and April 2020, 391 hemiarch replacements under moderate hypothermic circulatory arrest via median sternotomy were performed at our institution. Of these, 70 involved retrograde perfusion and 162 involved antegrade perfusion. Propensity score matching was used to compare 61 pairs of retrograde and antegrade cases. RESULTS: Retrograde and antegrade strategy under moderate hypothermia resulted in comparable operative mortality (3.3% vs. 1.6%, P > 0.99), permanent neurological deficits (8.5% vs. 6.6%, P > 0.99), and temporary neurological deficits (24.6% vs. 39.3%, P = 0.33). Retrograde surgery was associated with shorter circulatory arrest times (31.4 ± 8.2 min vs. 37.4 ± 12.2 min, P = 0.005) and fewer red blood cell transfusions (4.6 ± 3.9 units vs. 8.2 ± 5.1 units, P < 0.001) than those with antegrade surgery. CONCLUSIONS: Retrograde cerebral perfusion under moderate hypothermia for hemiarch replacement yields excellent operative outcomes, equivalent to those achieved using an antegrade strategy.

Atypical presentation of isolated traumatic ascending aortic dissection with cardiac tamponade.

Blunt traumatic aortic injury is a rare but life-threatening condition, usually following high-energy trauma. We present the case of a 79-year-old man who was transferred to a hospital complaining of nausea after being struck on the chest. Computed tomography led to diagnosis of ascending aortic dissection with cardiac tamponade. Emergent ascending aortic replacement was performed successfully and he was discharged home on postoperative day 24 without any complications. The key to early diagnosis of blunt traumatic aortic injury is careful and detailed history-taking. If trauma patients complain of unexplained symptoms, the threshold for conducting computed tomography should be lowered to avoid misdiagnosis or therapeutic delay.

[Surgical treatment of coarctation of the aorta concomitant with left main coronary stenosis; report of a case].

A 60-year-old male was referred to our institution for investigation of intractable hypertension. Coarctation of the aorta was detected by computed tomography (CT). Bilateral internal thoracic arteries played an important role as a collateral source to the lower extremity. Coronary angiography showed stenosis at the ostium of left main trunk. Ascending aorta to bilateral external iliac artery bypass grafting and off-pump coronary artery bypass grafting (OPCAB) was done simultaneously, this is because we had to harvest left internal thoracic artery as a conduit for coronary artery bypass grafting(CABG).Postoperative course was uneventful. The patient was discharged 10 days after the operation. We could perform less-invasive surgery despite the simultaneous operations.