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1.
J Cardiothorac Surg ; 16(1): 335, 2021 Nov 21.
Artigo em Inglês | MEDLINE | ID: mdl-34802439

RESUMO

BACKGROUND: Median sternotomy remains the most common approach in cardiovascular surgery. Recently, minimally invasive procedures, such as minimally invasive cardiac surgery, robot surgery, and catheter therapy have been developed in cardiovascular surgery. However, all these surgeries cannot be performed by minimally invasive approaches. Several complications associated with median sternotomy have been reported, although post-sternotomy hemorrhage from the posterior intercostal artery is extremely rare. CASE PRESENTATION: We present a case of posterior intercostal artery bleeding following lower partial sternotomy. A 79-year-old man underwent aortic valve replacement using lower partial median inverted L-shaped sternotomy that cut into the right second intercostal space. A postoperative chest radiograph indicated a hematoma in the right upper chest wall and pleural effusion. Hence, we inserted a drainage tube immediately. Approximately 2 hours after the surgery, his blood pressure gradually decreased. Blood drainage was observed from the tube, and the amount of blood drainage was not large. Contrast-enhanced computed tomography revealed a huge hematoma and hemorrhage from the fourth right posterior intercostal artery. Immediately, we performed emergency surgery. The lower partial sternotomy was repeated. We detected the origin of the bleeding that was identified in the right fourth posterior intercostal artery, and the bleeding was stopped. The postoperative course was uneventful. CONCLUSIONS: This case highlights the possibility of intraoperative bleeding from the intercostal artery, even in the absence of clearly rib fracture. In our case, we did not identify the cause of bleeding, although we suggest the inhomogeneous stress on the posterior ribs upon attaching the sternal retractor for lower partial sternotomy may have affected the posterior intercostal artery.


Assuntos
Implante de Prótese de Valva Cardíaca , Esternotomia , Idoso , Valva Aórtica/cirurgia , Artérias , Hemorragia/etiologia , Humanos , Masculino , Procedimentos Cirúrgicos Minimamente Invasivos , Esternotomia/efeitos adversos , Resultado do Tratamento
2.
Artigo em Inglês | MEDLINE | ID: mdl-34705351

RESUMO

The cardiac multimedia literature is abundant, but a significant gap exists in educational videos demonstrating routine essential steps such as the sternotomy or the closure. These components are common and carry significant mortality and morbidity should a sternal complication occur, highlighting the importance for the cardiothoracic surgeon to master these steps.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Esternotomia , Hemostasia , Humanos , Esterno/cirurgia , Técnicas de Fechamento de Ferimentos
3.
J Cardiothorac Surg ; 16(1): 287, 2021 Oct 09.
Artigo em Inglês | MEDLINE | ID: mdl-34627311

RESUMO

OBJECTIVE: Postoperative pulmonary complications (PPCs) are common incidents associated with an increased hospital stay, readmissions into the intensive care unit (ICU), increased costs, and mortality after cardiac surgery. Our study aims to analyze whether minimally invasive valve surgery (MIVS) can reduce the incidence of postoperative pulmonary complications compared to the full median sternotomy (FS) approach. METHODS: We reviewed the records of 1076 patients who underwent isolated mitral or aortic valve surgery (80 MIVS and 996 FS) in our institution between January 2015 and December 2019. Propensity score-matching analysis was used to compare outcomes between the groups and to reduce selection bias. RESULTS: Propensity score matching revealed no significant difference in hospital mortality between the groups. The incidence of PPCs was significantly less in the MIVS group than in the FS group (19% vs. 69%, respectively; P < 0.0001). The most common PPCs were atelectasis (P = 0.034), pleural effusions (P = 0.042), and pulmonary infection (P = 0.001). Prolonged mechanical ventilation time (> 24 h) (P = 0.016), blood transfusion amount (P = 0.006), length of hospital stay (P < 0.0001), and ICU stay (P < 0.0001) were significantly less in the MIVS group. Cardiopulmonary bypass (CBP), aortic cross-clamping, and operative time intervals were significantly longer in the MIVS group than in the matched FS group (P < 0.001). A multivariable analysis revealed a decreased risk of PPCs in patients undergoing MIVS (odds ratio, 0.25; 95% confidence interval, 0.006-0.180; P < 0.0001). CONCLUSION: MIVS for isolated valve surgery reduces the risk of PPCs compared with the FS approach.


Assuntos
Implante de Prótese de Valva Cardíaca , Esternotomia , Valva Aórtica/cirurgia , Implante de Prótese de Valva Cardíaca/efeitos adversos , Humanos , Incidência , Tempo de Internação , Procedimentos Cirúrgicos Minimamente Invasivos , Valva Mitral/cirurgia , Pontuação de Propensão , Estudos Retrospectivos , Esternotomia/efeitos adversos , Resultado do Tratamento
4.
Zhonghua Wai Ke Za Zhi ; 59(10): 861-866, 2021 Oct 01.
Artigo em Chinês | MEDLINE | ID: mdl-34619913

RESUMO

Objective: To examine the early outcome of valve sparing aortic root replacement with reimplantation technique (David procedure) with partial upper sternotomy. Methods: From April 2016 to April 2020, 31 patients underwent valve sparing aortic root replacement under partial upper sternotomy at Vascular Surgery Center, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College. There were 28 males and 3 females, aging (44±13) years (range: 11 to 65 years). Preoperative aortic regurgitation was found greater than moderate in 15 patients, moderate in 6 patients and less than moderate in 10 patients. The diameter of aortic annulus was (26±3) mm (range: 21 to 34 mm), the diameter of aortic sinus was (51±6) mm (range: 41 to 68 mm), the diameter of ascending aorta was (43±8) mm (range: 26 to 62 mm). The preoperative ejection fraction was (65±4) % (range: 59% to 72%) and left ventricular end-diastolic diameter was (55±6) mm (range: 42 to 68 mm). All cases were treated with David Ⅰ procedure, including simple David procedure in 26 patients, David+ascending aorta and partial aortic arch replacement in 3 patients, David+thoracic endovascular aortic repair in 1 patient, David+stent elephant trunk implantation in 1 patient. Results: The operation time, cardiopulmonary bypass time and aortic cross-clamping time were (330±58) minutes (range: 214 to 481 minutes), (138±23) minutes (range: 106 to 192 minutes) and (108±17) minutes (range: 82 to 154 minutes), respectively. There were no death and serious complications (stroke, myocardial infarction, renal insufficiency, severe infection, etc.). The postoperative drainage volume within 24 hours was (314±145) ml (range: 130 to 830 ml). The intubation time was (14±3) hours (range: 8 to 21 hours), and the ICU time was (M(QR)) 2.1(1.5) days (range: 1.0 to 5.0 days). Eight patients had no blood transfusion, the proportion of red blood cell use was 9.7% (3/31), plasma use was 22.6% (7/31), and platelet use was 71.0% (22/31). The postoperative left ventricular ejection fraction was (62±4)% (range: 54% to 69%), and left ventricular end-diastolic diameter was (48±4) mm (range: 39 to 56 mm). After operation, aortic regurgitation was significantly improved, with no more than moderate regurgitation, small to moderate regurgitation in 3 patients, minor regurgitation in 3 patients, micro regurgitation in 12 patients and no regurgitation in 13 patients. The follow-up period was 3.5(6.1) months (range: 2.0 to 39.0 months). Echocardiographic follow-up data were obtained in 26 cases, including moderate regurgitation in 1 patient, small to moderate regurgitation in 9 patients, minor regurgitation in 5 patients, micro regurgitation in 6 patients and no regurgitation in 5 patients. There were no major adverse cardiovascular events and aortic events during the follow-up period. No patient was reoperated for aortic regurgitation. Conclusion: Valve sparing aortic root replacement under partial upper sternotomy is safe and feasible, and the early result is satisfactory.


Assuntos
Valva Aórtica , Esternotomia , Aorta , Feminino , Humanos , Masculino , Reimplante , Volume Sistólico , Função Ventricular Esquerda
5.
J Int Med Res ; 49(9): 3000605211041265, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34551599

RESUMO

OBJECTIVE: To compare the sternal fixation effect of a polyetheretherketone (PEEK) cable product and stainless steel wire after median sternotomy. METHODS: A multicentre retrospective clinical trial was conducted in patients that underwent median sternotomy for a range of surgical reasons. The sternum was fixed using PEEK sternal cables in the experimental group and stainless steel wires in the control group. The general patient state, product manoeuvrability, bone and wound healing state and blood test results were evaluated at seven visits during the preoperative, surgical and follow-up periods. RESULTS: A total of 108 patients (54 in each group) were included in the analysis at the final 180-day follow-up. The sternum was successfully closed using PEEK cables or steel wires in all patients and all healed well. No pathological changes were found on the X-ray imaging. Computed tomography imaging confirmed ideal fracture healing. No significant difference was found between the experimental group and the control group in outcomes. CONCLUSION: PEEK cables are easy to implant and show desirable effectiveness in sternal fixation without any observed side-effects.


Assuntos
Aço Inoxidável , Esternotomia , Benzofenonas , Fios Ortopédicos , Humanos , Polímeros , Estudos Retrospectivos , Esterno/diagnóstico por imagem , Esterno/cirurgia
6.
J Card Surg ; 36(11): 4083-4089, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34473370

RESUMO

OBJECTIVE: The optimal management of deep sternal wound infection (DWSI) remains controversial. Our objective was to evaluate outcomes of patients with DSWI managed with transposition of laparoscopically harvested omentum (LHO). METHODS: Between 2000 and 2020, a total of 38,623 adult patients who underwent full median sternotomy for cardiac surgery were analyzed retrospectively at our institution. DSWI occurred in 455 (1.2%), of whom 364 (93.2%) were managed with pectoralis myocutaneous flap (PMF) and 33 (7.2%) with LHO. Univariate and multivariate analysis models were used to determine predictors of cumulative late mortality and adjusted survival curves were generated. RESULTS: Among patients who received LHO, average age was 65.7 ± 9.7 years and a larger proportion of patients were male. A majority of patients (88%) had coronary bypass surgery, with bilateral internal mammary arteries use in only 21.2%. Mean length of stay (LOS) was 58.90 days and early hospital mortality occurred in 4 patients (12.1%). Patients who received LHO compared to only PMF had larger body mass index and had more heart failure. Furthermore, the hospital LOS was also significantly prolonged in the LHO group (58.9 vs. 27.4 days, p = .002), with a slightly higher in-hospital mortality (12.1% vs. 3.3%, p = .03). Late survival for LHO patients at 5 and 10 years was 71.9% and 44.8%, respectively. CONCLUSION: Use of LHO is a safe and viable alternative to traditional myocutaneous flaps to manage complex DSWI. Early and late survival were favorable in this high-risk population.


Assuntos
Omento , Infecção da Ferida Cirúrgica , Adulto , Idoso , Humanos , Masculino , Pessoa de Meia-Idade , Omento/cirurgia , Estudos Retrospectivos , Fatores de Risco , Esternotomia , Esterno/cirurgia
7.
J Coll Physicians Surg Pak ; 31(9): 1069-1074, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34500523

RESUMO

OBJECTIVE: To determine the efficacy of a sternal wire system in secondary sternal dehiscence after repeat closure of the sternum, following surgical revision after open heart surgery. STUDY DESIGN: Case-control study. PLACE AND DURATION OF STUDY: Department of Cardiovascular Surgery, Zonguldak Bülent Ecevit University, Zonguldak, Turkey; and Turkey Yuksek Ihtisas Training and Research Hospital, Turkey, from January 2015 to May 2019. METHODOLOGY: Patients, who underwent open heart surgery with median sternotomy, were included in this retrospective study. The patients were divided into two groups, according to the sternal closure material. The time of the sternal reconstruction surgery, because of sternal dehiscence, fracture, broken sternal wire(s) or cable(s) after the first revision surgery, was noted for each patient. RESULTS: A total of 389 patients were identified. Group 1 included 72 (50%) patients whose sternums were closed with a sternal cable system; and Group 2 included 72 (50%) patients whose sternums were closed with conventional steel wires after propensity matching. The duration of cardiopulmonary bypass, number of intra-aortic balloon pumps used, and number of extracorporeal membrane oxygenators used were significantly higher in Group 1 (p = 0.007, p = 0.034, and p = 0.028, respectively). The number of emergency operations was significantly higher in Group 2 (p = 0.021). There was no significant difference in terms of secondary sternal dehiscence between the groups (p = 0.366). CONCLUSION: Application of the sternal wire system in revisional open heart surgery is not more effective than conventional steel wire at preventing secondary sternal dehiscence. Key Words: Sternal dehiscence, Sternal cable, Sternal wire, Open heart surgery, Postoperative revision.


Assuntos
Esterno , Deiscência da Ferida Operatória , Fios Ortopédicos , Estudos de Casos e Controles , Humanos , Reoperação , Estudos Retrospectivos , Esternotomia/efeitos adversos , Esterno/cirurgia , Deiscência da Ferida Operatória/etiologia , Deiscência da Ferida Operatória/prevenção & controle , Deiscência da Ferida Operatória/cirurgia
8.
Kyobu Geka ; 74(10): 746-751, 2021 Sep.
Artigo em Japonês | MEDLINE | ID: mdl-34548440

RESUMO

It has been reported that there are some risks of coronary artery graft injury while redo sternotomy was required for valve surgery after coronary artery bypass grafting (CABG). Also it is well known that clinical results after graft injury was poor. For avoiding graft injury, coronary artery graft must be placed away from the sternum at the time of initial CABG. For redo sternotomy, 3-dimensional-computed tomography can be useful. For aortic valve surgery after CABG, treatment of patent in-situ graft have to be discussed. For common practice, dissecting and clamping the patent in-situ graft during cardiac arrest were required. However, there are some reports showing good clinical results with moderate hypothermia, non-dissection and non-clamping graft. Furthermore, less mobidity rate results of transcatheter aortic valve implantation( TAVI) after CABG was reported. For mitral valve surgery after CABG, right mini-thoracotomy was reported as preferred procedure recently. Dissection area could be reduced than re-median sternotomy, although clamping aorta and patent graft were technically difficult. Two procedures were reported such as hypothermia and ventricular fibrillation or normothermia and beating heart. MitraClip procedure can be considered for high risk patients. Newly developed surgical and catheter technique may change the strategy for heart valve disease after CABG.


Assuntos
Doenças das Valvas Cardíacas , Implante de Prótese de Valva Cardíaca , Ponte de Artéria Coronária , Doenças das Valvas Cardíacas/diagnóstico por imagem , Doenças das Valvas Cardíacas/cirurgia , Humanos , Esternotomia , Toracotomia
9.
Kyobu Geka ; 74(10): 758-762, 2021 Sep.
Artigo em Japonês | MEDLINE | ID: mdl-34548442

RESUMO

Transcatheter mitral valve intervention, including repair and replacement, has been developed as an alternative treatment to mitral valve surgery with advanced technology in recent years, but the therapeutic indication is still limited to only a part of all, high-risk or inoperable patients. Although reoperative valve surgery is generally known to be associated with increased morbidity and mortality, conventional mitral valve surgery after previous aortic valve replacement is needed due to limited usage of catheter intervention as increasing of aged population. It is usually necessary to undergo redo median sternotomy with care as same as other reoperation, or right thoracotomy approach in some cases. In any cases, there is a tendency to poor visualization of the mitral valve, in especially, a view of anterior annulus due to rigid aortic prosthetic cuff. Of course, optimal visualization of the mitral valve is a successful key factor in reliable maneuver for either repair or replacement. Here we describe operative tips and pitfalls including operative indication, re-opening of the chest, left atrial approach.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Implante de Prótese de Valva Cardíaca , Idoso , Valva Aórtica/cirurgia , Humanos , Valva Mitral/cirurgia , Reoperação , Esternotomia , Toracotomia , Resultado do Tratamento
10.
J Card Surg ; 36(12): 4762-4765, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34541714

RESUMO

Pulmonary artery (PA) pseudoaneurysms are a rare but potentially lethal diagnosis. They can be further categorized by etiology or location and are typically successfully treated with endovascular therapies. However, they occasionally require operative intervention. Here, we present a case of a patient who presented with a central PA pseudoaneurysm on computed tomography scan with unclear etiology that was initially treated with conservative management. However, this was noted to have rapid enlargement on interval imaging necessitating urgent surgical intervention. The patient underwent a median sternotomy, anterior PA arteriotomy for exposure, exclusion of the posterior artery pseudoaneurysm with a bovine pericardial patch, and closure of the anterior arteriotomy with a bovine pericardial patch. The patient did well and was discharged on postoperative day 11 with repeat imaging showing resolution.


Assuntos
Falso Aneurisma , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/cirurgia , Animais , Bovinos , Humanos , Artéria Pulmonar/diagnóstico por imagem , Artéria Pulmonar/cirurgia , Esternotomia , Tomografia Computadorizada por Raios X , Procedimentos Cirúrgicos Vasculares
11.
J Cardiothorac Surg ; 16(1): 266, 2021 Sep 20.
Artigo em Inglês | MEDLINE | ID: mdl-34544460

RESUMO

BACKGROUND: To compare the short-term safety and efficacy of right anterolateral minithoracotomy (ALMT) and median sternotomy (MS) for the surgical treatment of atrial septal defects (ASDs). METHODS: The PubMed, EMBASE, Web of Science, and Cochrane Library databases were searched for comparative studies focusing on surgical repair of ASDs via ALMT or MS published up to the end of April 27, 2020. We used random-effect or fixed-effect models to obtain pooled estimates. RESULTS: A total of 7 publications, including 665 patients (ALMT 296 and MS 369), were included. Age (WMD: 1.80 years, 95% CI 0.31-3.29), weight (WMD: - 0.91 kg, 95% CI - 5.57 to 3.75), sex distribution (OR: 1.00, 95% CI 0.74-1.35) and surgical type (patch or direct closure) (OR: 1.00, 95% CI 0.67-1.49) were comparable in the ALMT group and MS group. No significant differences in the success rate (OR 0.23; 95% CI 0.05-1.07) or severe complication rate (OR 1.46; 95% CI 0.41-5.22) were found between the ALMT group and the MS group. In addition, the differences in the cardiopulmonary bypass (CPB) time (WMD 6.33; 95% CI - 1.92 to 14.58 min, p = 0.13) and the operation time (WMD 5.23; 95% CI - 12.49 to 22.96 min, p = 0.56) between the ALMT group and the MS group were not statistically significant. However, the ALMT group had a significantly longer aortic cross-clamp time (2.37 min more, 95% CI 1.07-3.67 min, p = 0.0003). The intubation time was 1.82 h shorter (95% CI - 3.10 to - 0.55 h; p = 0.005), the intensive care unit (ICU) stay was 0.24 days shorter (95% CI - 0.44 to - 0.04 days; p = 0.02), and the postoperative hospital stay was 2.45 days shorter (95% CI - 3.01 to - 1.88 days; p < 0.00001) in the ALMT group than in the MS group. Furthermore, the incision length was significantly shortened by 8.97 cm in the ALMT group compared with the MS group (95% CI - 9.36 to - 8.58 cm; p < 0.00001). CONCLUSIONS: In the surgical treatment of ASD, ALMT and MS are equally safe and effective in terms of success rates and severe complication rates. The surgical procedures are equally difficult, but ALMT is associated with a faster functional recovery and better cosmetic results. Compared to MS, ALMT is the better choice for select ASD patients.


Assuntos
Comunicação Interatrial , Esternotomia , Comunicação Interatrial/cirurgia , Humanos , Recém-Nascido , Tempo de Internação , Procedimentos Cirúrgicos Minimamente Invasivos , Toracotomia , Resultado do Tratamento
12.
Interact Cardiovasc Thorac Surg ; 33(5): 822-823, 2021 Oct 29.
Artigo em Inglês | MEDLINE | ID: mdl-34405871

RESUMO

Left ventricular lipoma is a rare intracardiac tumour that is usually resected through sternotomy to effectively explore the left ventricular cavity. We introduce a simple technique to expose the left ventricular cavity and resect the intraventricular lipoma using a rolled up flexible ruler through right mini-thoracotomy. Imaging studies and gross and microscopic photography of intraventricular lipoma are presented in this report.


Assuntos
Lipoma , Toracotomia , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/cirurgia , Humanos , Lipoma/diagnóstico por imagem , Lipoma/cirurgia , Esternotomia
13.
J Cardiothorac Surg ; 16(1): 228, 2021 Aug 10.
Artigo em Inglês | MEDLINE | ID: mdl-34376231

RESUMO

OBJECTIVES: Conventional mitral valve surgery through median sternotomy improves long-term survival with acceptable morbidity and mortality. However, less-invasive approaches to mitral valve surgery are now increasingly employed. Whether minimally invasive mitral valve surgery is superior to conventional surgery is uncertain. METHODS: A retrospective analysis of patients who underwent mitral valve surgery via minithoracotomy or median sternotomy between 2012 and 2018. A propensity score-matched analysis was generated to eliminate differences in relevant preoperative risk factors between the two groups. RESULTS: Data from 525 patients were evaluated, 189 underwent minithoracotomy and 336 underwent median sternotomy. The 30 day mortality was similar between the minithoracotomy and conventional surgery groups (1 and 3%, respectively; p = 0.25). No differences were seen in the incidence of stroke (p = 1.00), surgical site infections (p = 0.09), or myocardial infarction (p = 0.23), or in total hospital cost (p = 0.48). However, the minimally invasive approach was associated with fewer patients receiving transfusions (59% versus 76% in the conventional group; p = 0.001) or requiring reoperation for bleeding (3% versus 9%, respectively; p = 0.03). There were no significant differences in 5 year survival between the minithoracotomy and conventional surgery groups (93% versus 86%, respectively; p = 0.21) and freedom from mitral valve reoperation (95% versus 94%, respectively; p = 0.79). CONCLUSIONS: In patients undergoing mitral valve surgery, a minimally invasive approach is feasible, safe, and reproducible with excellent short-term outcomes; mid-term outcomes and efficacy were also seen to be comparable to conventional sternotomy.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Doenças das Valvas Cardíacas/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos , Valva Mitral/cirurgia , Esternotomia , Toracotomia/métodos , Idoso , Procedimentos Cirúrgicos Cardíacos/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Pontuação de Propensão , Estudos Retrospectivos , Fatores de Risco , Esternotomia/métodos , Resultado do Tratamento
14.
Plast Reconstr Surg ; 148(2): 429-437, 2021 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-34398095

RESUMO

BACKGROUND: Sternal wound infection and dehiscence following cardiac surgery remain difficult clinical problems with high morbidity. Older classification systems regarding timing to reconstruction do not take into account recent improvements in critical care, wound vacuum-assisted closure use, or next-generation antibiotic therapies, which may prolong time to reconstruction. METHODS: Records of patients undergoing sternal wound reconstruction performed by the senior author (J.A.A.) from 1996 to 2018 at a high-volume cardiac surgery center were reviewed. Indications included sternal wound infection or dehiscence. All patients underwent single-stage removal of hardware, débridement, and flap closure. Patients were divided into two groups based on timing of wound closure after cardiac surgery: less than 30 days or greater than or equal to 30 days. RESULTS: Of the 505 patients identified during the study period, 330 had sufficient data for analysis. Mean time to sternal wound surgery was 15.7 days in the early group compared to 64.4 days (p < 0.01) beyond 30 days. Postdébridement cultures were positive in 72 percent versus 62.5 percent of patients (p = 0.11), whereas rates of postoperative infection were significantly higher in the delayed group: 1.9 percent versus 9.5 percent (p < 0.01). Partial wound dehiscence rates were also higher after 30 days (1.9 percent versus 11.3 percent; p < 0.01), whereas total length of stay was decreased. Use of wound vacuum-assisted closure was significantly associated with reconstruction beyond 30 days (p < 0.01). CONCLUSIONS: Although performing sternal wound reconstruction more than 30 days after initial cardiac surgery was associated with a shorter overall hospital length of stay and higher extubation rates in the operating room, these patients also had elevated postoperative infection and wound complication rates. The authors thus recommend not delaying definitive surgical reconstruction when possible. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.


Assuntos
Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Procedimentos Cirúrgicos Reconstrutivos/estatística & dados numéricos , Esternotomia/efeitos adversos , Infecção da Ferida Cirúrgica/epidemiologia , Técnicas de Fechamento de Ferimentos/estatística & dados numéricos , Idoso , Procedimentos Cirúrgicos Cardíacos/métodos , Desbridamento/métodos , Desbridamento/estatística & dados numéricos , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Estudos Retrospectivos , Esterno/cirurgia , Retalhos Cirúrgicos , Infecção da Ferida Cirúrgica/etiologia , Infecção da Ferida Cirúrgica/prevenção & controle , Fatores de Tempo , Tempo para o Tratamento/estatística & dados numéricos , Resultado do Tratamento , Técnicas de Fechamento de Ferimentos/efeitos adversos , Cicatrização
15.
J Card Surg ; 36(9): 3131-3137, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34212430

RESUMO

AIMS: This study aimed to investigate the safety, feasibility and, availability of perimembranous ventricular septal defect (PmVSD) closure via a left parasternal ultra-minimal trans intercostal incision in children. METHODS AND RESULTS: From January 2015 to January 2019, 131 children with restrictive PmVSDs were enrolled in this study and successfully done in 126 patients (96.18%). PmVSDs were occluded via an ultra-minimal trans intercostal incision (≤1 cm), and the entire occlusive process was guided and monitored by TEE. A pericardium hanging technique was employed without sternal incision. PmVSDs were closed through a short delivery sheath assembled using a concentric occluder device. All patients were followed up for a period ranging from18 months to 24 months. Thirteen patients with PmVSD had aneurysm of membranous septum (AMS). Multistream (≥2) PmVSDs with AMS were found in 11 cases. After the operation, mild residual shunt beside the amplatzer occluder in one patient was found and had self-healing result during the 5-month follow-up period. Five patients transferred to ventricular septal defect repair operation under direct visualization with a cardiopulmonary bypass. One reason was ventricular fibrillation when guidewire passed the PmVSD, another was device dislocation, and others were the guidewire cannot pass through the PmVSD. CONCLUSIONS: PmVSDs closure using a concentric occluder via a left parasternal ultra-minimal trans intercostal incision under TEE guidance is feasible, safe, and effective in children. This approach can be considered as an alternative treatment to open-heart surgery for restrictive PmVSDs.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Comunicação Interventricular , Dispositivo para Oclusão Septal , Cateterismo Cardíaco , Criança , Ecocardiografia Transesofagiana , Comunicação Interventricular/diagnóstico por imagem , Comunicação Interventricular/cirurgia , Humanos , Desenho de Prótese , Esternotomia , Resultado do Tratamento
16.
J Card Surg ; 36(9): 3177-3183, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34091951

RESUMO

BACKGROUND: Although the incidence of mitral valve (MV) surgery after previous open-heart surgery is increasing, there is no consensus regarding the optimal surgical approach. Reoperative MV surgery is most commonly performed via sternotomy (ST). We sought to determine whether minimally-invasive (MIS) reoperative MV surgery is safe and feasible. METHODS: All patients with a history of ST undergoing MV surgery with or without concomitant tricuspid or atrial fibrillation surgery at a single institution from 2007 to 2018 were retrospectively reviewed. ST and MIS approaches were compared using propensity-matched analysis. The coprimary endpoints were operative mortality and 1-year survival, and secondary endpoints were operative complications and length of stay. RESULTS: A total of 305 isolated MV reoperations were performed: 199 (65%) MIS and 106 (35%) ST. MIS patients were older than ST patients (71 [63, 76.5] vs. 66 [56, 72] years, p < .01), more likely to have undergone prior coronary artery bypass grafting (57% vs. 27%, p < .01), and less likely to have had prior valve surgery (55% vs. 78%, p < .01). In unmatched comparisons, operative mortality was significantly lower among MIS patients (3.0% vs. 8.5%, p = .04), but 1-year mortality was similar (14.4% vs. 15.6%, p = .8). After propensity matching, 88 pairs had excellent balance across baseline characteristics. Mortality was similar among MIS and ST patients at 30 days (3.4% vs. 8%, p = .19) and 1 year (15.9% vs. 16.5%, p = .9). RBC and fresh frozen plasma transfusions were significantly lower in the MIS group (p < .01). CONCLUSIONS: A minimally invasive approach is a safe alternative in patients with prior ST undergoing MV surgery.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Implante de Prótese de Valva Cardíaca , Humanos , Procedimentos Cirúrgicos Minimamente Invasivos , Valva Mitral/cirurgia , Estudos Retrospectivos , Esternotomia , Resultado do Tratamento
17.
BMC Cardiovasc Disord ; 21(1): 314, 2021 06 26.
Artigo em Inglês | MEDLINE | ID: mdl-34174818

RESUMO

BACKGROUND: Mitral valve (MV) surgery has traditionally been performed by conventional sternotomy (CS), but more recently minimally invasive surgery (MIS) has become another treatment option. The aim of this study is to compare short- and long-term results of MV surgery after CS and MIS. METHODS: This study was a retrospective propensity-matched analysis of MV operations between January 2005 and December 2015. RESULTS: Among 1357 patients, 496 underwent CS and 861 MIS. Matching resulted in 422 patients per group. The procedure time was longer with MIS than CS (192 vs. 185 min; p = 0.002) as was cardiopulmonary bypass time (133 vs. 101 min; p < 0.001) and X-clamp time (80 vs. 71 min; p < 0.001). 'Short-term' successful valve repair was higher with MIS (96.0% vs. 76.0%, p < 0.001). Length of hospital stay was shorter in MIS than CS patients (10 vs. 11 days; p = 0.001). There was no difference in the overall 30-day mortality rate. Cardiovascular death was lower after MIS (1.2%) compared with CS (3.8%; OR 0.30; 95%CI 0.11-0.84). The difference did not remain significant after adjustment for procedural differences (aOR 0.40; 95%CI 0.13-1.25). Pacemaker was required less often after MIS (3.3%) than CS (11.2%; aOR 0.31; 95%CI 0.16-0.61), and acute renal failure was less common (2.1% vs. 11.9%; aOR 0.22; 95%CI 0.10-0.48). There were no significant differences with respect to rates of stroke, myocardial infarction or repeat MV surgery. The 7-year survival rate was significantly better after MIS (88.5%) than CS (74.8%; aHR 0.44, 95%CI 0.31-0.64). CONCLUSION: This study demonstrates that good results for MV surgery can be obtained with MIS, achieving a high MV repair rate, low peri-procedural morbidity and mortality, and improved long-term survival.


Assuntos
Doenças das Valvas Cardíacas/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos , Valva Mitral/cirurgia , Esternotomia , Idoso , Feminino , Alemanha , Doenças das Valvas Cardíacas/diagnóstico por imagem , Doenças das Valvas Cardíacas/mortalidade , Doenças das Valvas Cardíacas/fisiopatologia , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Procedimentos Cirúrgicos Minimamente Invasivos/mortalidade , Valva Mitral/diagnóstico por imagem , Valva Mitral/fisiopatologia , Complicações Pós-Operatórias/mortalidade , Complicações Pós-Operatórias/terapia , Pontuação de Propensão , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Esternotomia/efeitos adversos , Esternotomia/mortalidade , Fatores de Tempo , Resultado do Tratamento
18.
Gen Thorac Cardiovasc Surg ; 69(12): 1527-1531, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34076839

RESUMO

BACKGROUND: The mini-sternotomy has become a common approach of choice for a wide range of congenital defects requiring minimally invasive surgery. Here, we aimed to present closed heart surgery results via limited upper mini-sternotomy in the newborn and infants. METHODS: A total of 46 infants who underwent pulmonary artery banding, patent ductus arteriosus ligation, and aortopexy via limited upper mini-sternotomy between December 2017 and October 2020 were enrolled. Patients included 26 males and 20 females with ages ranging from 2 days to 12 months (median age 3.25 ± 0.9 months). The weight ranged from 0.7 kg to 8 kg (median weight 3.6 ± 1.8 kg). These patients were evaluated retrospectively in terms of clinical, preoperative, intraoperative, and postoperative parameters. RESULTS: Closed heart surgery procedures were corrected successfully without adverse events intraoperatively. The median operation time was 32 min (32 ± 7 min). The limited upper mini-sternotomy was performed on 46 patients, including the pulmonary banding (18 patients), PDA ligation (16 patients), and aortopexy (12 patients). No patients required conversion to full sternotomy or to extend the incision. Re-intervention to adjust the tightness of the band was required in 1 patient. There were 4 cases of mortality (8.6%). All four death cases had comorbidity and low birth weight (2500 g or less). CONCLUSION: Limited upper mini-sternotomy is a technically feasible, safe, and effective approach that providing an adequately surgical view in closed heart surgery to reduce the invasiveness of the closed heart surgical repair via median sternotomy or thoracotomy approach.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Esternotomia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Procedimentos Cirúrgicos Minimamente Invasivos , Estudos Retrospectivos , Toracotomia , Resultado do Tratamento
19.
Gen Thorac Cardiovasc Surg ; 69(12): 1532-1538, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34089477

RESUMO

OBJECTIVES: Although endovascular repair has become an alternative treatment for coarctation of the aorta (CoA) in adults, open repair provides concomitant repair of other cardiac complications, including post-stenotic aneurysm, ascending aortic aneurysm, and intracardiac diseases. We evaluated open anatomical repair for CoA repair in adults. METHODS: Eleven patients (6 men, age range 21-63 years) underwent primary CoA repair. Complicating conditions included post-stenotic aortic aneurysm in the descending aorta in 5 patients (45.5%) and ascending aortic aneurysm in 3 (27.3%). Two patients (18.2%) had a bicuspid aortic valve, and one (9.1%) had a quadricuspid aortic valve. Ventricular septal defect was detected in 1 patient (9.1%). Eight patients (72.7%) underwent descending aorta replacement through a left thoracotomy, comprising partial cardiopulmonary bypass in 4 and deep hypothermic circulatory arrest in 4. Of those, the left subclavian artery was reconstructed in 4 patients. The remaining 3 patients (27.3%) underwent total arch replacement, through a median sternotomy in 1 and using a combination of median sternotomy and thoracotomy in 2. RESULTS: No in-hospital mortality was observed. No spinal cord ischemia or neurological events were encountered, but 1 patient (9.1%) who underwent CoA repair via median sternotomy and thoracotomy required prolonged ventilatory support for more than 48 h. During the follow-up of 90 months (interquartile range 65-124 months), no patient died or required reintervention for the repaired segment. CONCLUSIONS: CoA in adults could be anatomically repaired with graft replacement both through the median sternotomy, the left thoracotomy, and the combination of both approaches, according to the complicated aortic or intracardiac lesions.


Assuntos
Coartação Aórtica , Adulto , Aorta/cirurgia , Aorta Torácica/cirurgia , Coartação Aórtica/diagnóstico por imagem , Coartação Aórtica/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Esternotomia , Toracotomia , Resultado do Tratamento , Adulto Jovem
20.
Heart Surg Forum ; 24(3): E502-E505, 2021 06 10.
Artigo em Inglês | MEDLINE | ID: mdl-34173764

RESUMO

OBJECTIVE: To investigate the feasibility and effect of minimal media lower hemisternotomy for cardiac surgery under cardiopulmonary bypass (CPB) in infant congenital heart disease. METHODS: In our hospital from May 2019 to October 2019, 170 infants with congenital heart disease underwent surgical treatment (median age 6.6 months; weight 6.0 kg). They were divided into 2 groups: those with conventional chest median incision and those with minimal sternotomy. Minimal lower hemisternotomy began from the third intercostal level and ended 0.5 cm above the xiphoid, just enough to insert a small sternal distractor. RESULTS: There was no significant difference between the 2 groups in CPB time. The operation time of small incision group was slightly longer (P < .05). There was no difference in prognosis between the 2 groups, but the wound length of the small incision group was significantly reduced (4.0 ± 0.5 versus 7.8 ± 0.8 cm, P < .05). Time of intensive care unit and hospital stay was shorter among hemisternotomy patients at a statistically significant level (P < .05). CONCLUSION: Minimal media lower hemisternotomy with the basic advantages of the sternal incision can expose the various parts of the heart, which meets most cardiac exploration and surgical operation needs, and the incision may still be extended if necessary. Lower hemisternotomy appears to be a safe, effective, and versatile alternative for many surgical interventions in infants with congenital heart disease.


Assuntos
Ponte Cardiopulmonar/métodos , Cardiopatias Congênitas/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Esternotomia/métodos , Esterno/cirurgia , Feminino , Seguimentos , Humanos , Lactente , Masculino , Duração da Cirurgia , Estudos Retrospectivos , Resultado do Tratamento
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