Search

Objectives: This study aimed to investigate changes in haematoma thickness during the early period and their association with disease progression in patients who received initial medical treatment for type A intramural haematoma (IMH)., Methods: Medical records and serial computed tomography angiography (CTA) images of patients who did not undergo emergency aortic repair for type A IMH upon presentation were retrospectively reviewed. The haematoma remodelling rate was determined using the following equation: thickness of the haematoma on the first CTA (mm) - thickness of the haematoma on the second CTA (mm)time between the first and second CTAs (h)., Results: Among the 40 patients included in this study, 38 were indicated for initial watch-and-wait strategy, whereas 2 were indicated for emergency aortic repair but declined it. During hospitalization, 10 patients developed disease progression, with 2 in-hospital mortality cases. Analysis of the haematoma remodelling rate in 39 patients revealed that such a rate was significantly associated with the reciprocal of the time from onset. Analysis of all 70 CTA examinations performed within 24 h after the onset of IMH showed that haematoma thickness was significantly associated with the logarithm of the time from onset. Initial regression of the haematoma was not necessarily associated with avoidance of disease progression., Conclusions: In type A IMH, the thickness of the haematoma in the ascending aorta tended to decrease in the very early period; however, prompt regression of the haematoma was not necessarily associated with avoidance of disease progression., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)

Objectives: We applied high-flow regional cerebral perfusion (HFRCP) for aortic arch reconstruction in neonates and infants by monitoring regional oxygen saturation of the thigh (rSO2T) using near-infrared spectroscopy to maintain peripheral perfusion. This study was designed to investigate the optimal perfusion flow of HFRCP for renal protection., Methods: From 2009 to 2021, 28 consecutive neonates and infants who underwent aortic arch reconstruction with HFRCP were enrolled. The median age of the patients was 27 days; the median body weight was 3.0 kg. In HFRCP, perfusion flow was targeted at approximately 80-100 mL/kg/min and then lowered corresponding to brain rSO2 levels and blood gas data. Isosorbide dinitrate and chlorpromazine were administered to enhance peripheral perfusion flow. Regional oxygen saturation of the forehead and thighs were monitored. The stage of acute kidney injury (AKI) was classified based on the Kidney Disease Improving Global Outcomes criteria., Results: No patients had neurological events and peritoneal dialysis after surgery. The incidence of AKI was 39.3% with only three patients having greater than stage 2 AKI. The maximum postoperative serum creatinine concentration was negatively associated with the lowest rSO2T during HFRCP. The rSO2T during HFRCP was a predictive factor for postoperative creatinine increase of ≧0.3 mg/dL. The area under receiver operating characteristic curve was 0.78 with the cutoff value of 48% for rSO2T., Conclusions: The rSO2T during HFRCP is a potential predictor of postoperative renal function. To prevent AKI, the rSO2T should be preserved more than 48% by increasing HFRCP flow., (© The Author(s) 2022. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery.)

Objectives: The aim of this study was to evaluate the mid-term outcomes after the repair of aortic arch using a standard patch augmentation technique., Methods: The study included all patients who underwent repair of a hypoplastic/interrupted aortic arch (IAA) in a single institute from June 2012 to December 2019 by a standardized patch augmentation (irrespective of concomitant intra-cardiac lesions). End points evaluated were reintervention for arch obstruction and persistent/new-onset hypertension., Results: The study included 149 patients [hypoplastic aortic arch, n = 92 (62%), IAA, n = 9 (6%), Norwood procedure, n = 48 (32%)]. The patch material used for augmentation of the aortic arch included pulmonary homograft (n = 120, 81%), homograft pericardium (n = 18, 12%), CardioCel® (n = 9, 6%) and glutaraldehyde-treated autologous pericardium (n = 2, 1%). The median age and weight at surgery were 7 days [interquartile range (IQR) 5-17 days] and 3.5 kg (IQR 3-3.9 kg), respectively. The median follow-up was 3.27 years (IQR 1.28, 5.08), range (0.02, 8.76). Freedom from reintervention at 1, 3 and 5 years was 95% [95% confidence interval (CI) = 89%, 98%], 93% (95% CI = 86%, 96%) and 93% (95% CI = 86%, 96%) respectively. One patient (0.6%) had persistent hypertension 8 years after correction for interrupted arch with truncus arteriosus., Conclusions: Repair of hypoplastic/IAA by transection and excision of all ductal tissue and standardized patch augmentation provide good mid-term durability. The freedom from reintervention at 5 years is >90%. The incidence of persistent systemic hypertension following arch reconstruction is low. The technique is reproducible and applicable irrespective of underlying arch anatomy., (© The Author(s) 2022. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery.)

Objectives: The aim of the study is to compare a technique of pump-controlled retrograde trial off (PCRTO) to insertion of an arterio-venous (AV) bridge to conduct a trial from venoarterial extracorporeal membrane oxygenation (VA ECMO)., Methods: We studied all patients who were weaned from VA ECMO using either PCRTO or AV bridging from November 2014 to April 2018. Demographic data, indications for ECMO, duration of ECMO, duration of trial period off ECMO and survival were compared between the 2 groups., Results: Seventy-nine patients were placed on VA ECMO from November 2014 to April 2018, of whom, 51 (65%) patients met the study inclusion criteria: 31 (61%) patients who had a trial period from VA ECMO using PCRTO and 20 (39%) patients who were weaned using an AV bridge. The indications for ECMO included cardiac (n = 16 and 11, respectively) and non-cardiac aetiologies (n = 15 and 9, respectively). There was 1 death in each group. The duration of the trial off VA ECMO was significantly shorter in the PCRTO group (median = 88.0 vs 196.6 min, P < 0.001). There were 2 conversions from PCRTO to AV bridging during the trial period off ECMO (2.9-kg neonate following a Norwood procedure and 2.2-kg patient following repair of ectopia cordis)., Conclusions: PCRTO is a safe, simple and reproducible approach for enabling a trial period while preserving the circuit during weaning from VA ECMO. In our study, the duration of the trial period off VA ECMO was significantly shorter in the PCRTO group. PCRTO avoids manipulation of the ECMO circuit, provides a 'stress test' to evaluate cardiorespiratory reserve during the trial period off ECMO, is applicable for a wide variety of cardiac and non-cardiac indications and facilitates multiple attempts at weaning from ECMO.

We investigated the prevalence, risk factors, and optimal timing of treatment for advanced periodontitis in patients undergoing elective heart valve surgery. Dental examinations were given to 209 patients (aged 65 ± 10 years) scheduled for valve surgery. Patients with no or mild periodontitis were assigned as controls (n = 105). Patients with advanced periodontitis underwent tooth extraction and curettage (n = 104), 68 of whom underwent tooth extraction within two weeks (short wait) and 36 of whom underwent extraction longer than two weeks, before surgery. The three groups (control, short, and long wait) were similar in age, gender, diseased valve, and type of surgery received. The average number of teeth extracted was 2.3 ± 2.3. In both univariate and multivariate analysis, risk factors for advanced periodontitis were history of smoking and heart failure. No complications arose from the extractions. Length of postoperative hospital stay, intrafebrile days, white blood cell count and serum C-reactive protein (assessed at postoperative days 1, 3 and 7) were similar among the three groups. During the mean follow-up period of 60 ± 16 months, no patient developed prosthetic valve endocarditis, and there were no postoperative deaths. In conclusion, we found no evidence that receipt and timing of dental treatment affected surgical success rates and postoperative course.

We report the surgical case of an eight-year-old girl who had a very rare combination of ventricular septal defect and abnormal aortic arch anatomy: right cervical aortic arch, left descending aorta and Kommerell's diverticulum from which the left subclavian artery arose with anomalous subaortic left brachiocephalic vein. She was confirmed the chromosomal 22q11.2 deletion.

Occlusion of the right coronary artery (RCA) ostium by an aortic cusp is a rare anomaly and can be a cause of sudden death. We report the case of a child with progressive stenosis of the right coronary ostium caused by a hypoplastic right coronary cusp that adhered to the aortic wall resulting in severe myocardial ischemia. The patient underwent a Ross-Konno operation with mitral valvuloplasty for congenital aortic valvular stenosis and mitral regurgitation caused by ischemia-induced posteromedial papillary muscle dysfunction. The myocardial ischemia was relieved by resection of the deformed pouch-like cusp to disclose the RCA ostium. Postoperative myocardial scintigraphy demonstrated no myocardial ischemia and multidetector computed tomography showed no coronary ostial stenosis.

It is still a highly difficult choice with no definitive answer whether to perform cardiac surgery on cardioplegically arrested heart or to operate on a beating heart, especially for patients with dilated cardiomyopathy (DCM). A 73-year-old man, who had ascending aortic aneurysm and DCM with ejection fraction (EF) of 16.5% and the left ventricle (LV) dyssynchrony, underwent graft replacement of the ascending aorta and implantation of the LV lead for cardiac resynchronization. The operation was carried out on a beating heart using tepid hypothermic cardiopulmonary bypass under antegrade/retrograde coronary blood perfusion during graft-aorta proximal anastomosis. Postoperative course was uneventful, though brain natriuretic peptide (BNP) showed transient elevation.

Anticoagulant therapy with warfarin is recommended in the early postoperative period after bioprosthetic aortic valve replacement (bAVR). However, some studies have addressed questions about its necessity. We evaluated postoperative coagulant activity data including prothrombin time-international normalized ratio (PT-INR) and thrombin-antithrombin III complex (TAT), measured every month in 21 bAVR patients during the 1st postoperative year. The results were divided into four time intervals after the operation: 1-3 months (P-1), 4-6 (P-2), 7-9 (P-3), and 10-12 (P-4). Warfarin, which was administrated in the first six months, in combination with aspirin, 100 mg, was started targeting PT-INR of 1.75-2.25. The values of TAT in P-1, P-2, P-3 and P-4 were 1.35+/-1.07 (ng/ml), 0.82+/-0.55, 0.81+/-0.78, and 0.72+/-0.62, respectively, showing significantly high values in P-1. Furthermore, the TAT values of P-1 and P-2 within the range of PT-INR from 1.75 to 2.25 were 1.15+/-0.71 (ng/ml) and 0.79+/-0.52; demonstrating statistical difference between them. The coagulant activity assessments suggest that warfarin administration during the first three months is necessary for bAVR patients to keep the TAT within the normal range.

Objective: We initiated an off-pump Fontan procedure by using temporary bypass from the inferior vena cava to the atrium and advanced the procedure in selected patients by simply cross-clamping the inferior vena cava. We aimed to investigate whether the off-pump Fontan procedure could ameliorate the volume and duration of pleural and peritoneal effusion., Methods: We retrospectively reviewed 74 patients (aged <4 years) who underwent Fontan completion between January 2001 and December 2006. The patients were classified into the following two groups: a cardiopulmonary bypass group in which cardiopulmonary bypass was required (n=27) and an off-pump group in which the procedure was completed without the use of cardiopulmonary bypass (n=47). A propensity score was used to control the treatment selection bias for the use of cardiopulmonary bypass. Fourteen patients from each group were successfully matched. Both bilateral pleural and peritoneal drainage tubes were placed in all the patients. The total volume of the effusion was measured at 6, 12, 24, 48, and 72h postoperatively and was corrected for body weight (kg) and intervals (h)., Results: Significantly reduced effusion (ml/kg/h) was noted in the off-pump group compared to the cardiopulmonary bypass group at 12h (cardiopulmonary bypass group, 8.6 [4.8-11.5]; off-pump group, 2.5 [1.2-5.4]; p=0.006) and at 48h (cardiopulmonary bypass group, 6.1 [2.6-9.9]; off-pump group, 1.4 [0.9-3.1]; p=0.008)., Conclusions: The off-pump Fontan procedure may reduce the volume of postoperative pleural and peritoneal effusion.