Journal of Cardiothoracic Surgery - Latest Articles

Impact of patient-prosthesis mismatch on 30-day outcomes in young and middle-aged patients undergoing aortic valve replacement

Daniel Hernández-Vaquero — 2012-05-15T00:00:00Z

Background: The impact of patient-prosthesis mismatch (PPM) on early outcomes in young and middleagedpatients undergoing conventional aortic valve replacement for severe aortic stenosisremains unknown. Our objective was to evaluate the incidence of some degree of PPM andits influence on early mortality and morbidity. Methods: We analyzed our single center experience in all patients <70 years undergoing first-timeisolated aortic valve replacement for severe stenosis in our center from September 2007 toSeptember 2011. PPM was defined as an indexed effective orifice area [less than or equal to] 0,85 cm2/m2. Theinfluence of PPM on early mortality and postoperative complications was studied usingpropensity score analysis. Follow up at 30 postoperative days was 100% complete. Results: Of 199 patients studied, 61 (30,7%) had some degree of PPM. PPM was associated with anincreased postoperative mortality (OR = 8,71; 95% CI = 1,67-45,29; p = 0,04) and majorpostoperative complications (OR = 2,96; CI = 1,03-8,55; p = 0,044). However, no associationbetween PPM and prolonged hospital or ICU stay was demonstrated. Conclusions: Moderate PPM is a common finding in young and middle-aged patients undergoing surgeryfor aortic valve replacement due to severe stenosis. In addition, its influence on earlyoutcomes may be relevant.

Equine pericardial roll graft replacement of infected pseudoaneurysm of the aortic arch

Hiroshi Kubota — 2012-05-14T00:00:00Z

Resection of the infected aorta, debridement of the surrounding tissue, in situ graftreplacement, and omentopexy is the standard procedure for treating infected aorticaneurysms, but the question of which graft material is optimal is still a matter of controversy.We recently treated a patient with an infected thoracic aortic aneurysm. The aneurysm waslocated in the proximal aortic arch. Because the patients had previously undergone abdominalsurgery, the aortic arch were replaced in situ with a branched equine pericardial roll grafts.The patient is alive and well 23 months after the operation.

Cardiac inflammatory myofibroblastic tumor: does it recur after complete surgical resection in an adult?

Xuedong Yang — 2012-05-04T00:00:00Z

Inflammatory myofibroblastic tumor is currently considered to be a low-grade neoplasm, and it rarely involves the heart. We reported a rare case of a 59-year-old female who received cardiac surgery for complete resection of inflammatory myofibroblastic tumor in the left atrium. Five months after surgery, the patient presented with acute cardiogenic pulmonary edema and subsequent sudden death due to a left atrial tumor which protruded into the left ventricle through mitral annulus during diastole. The recurrence of inflammatory myofibroblastic tumor in the left atrium was strongly suggested clinically.

Anterolateral minithoracotomy versus median sternotomy for the treatment of congenital heart defects: a meta-analysis and systematic review

Chao Ding — 2012-05-04T00:00:00Z

Background: Anterolateral Minithoracotomy (ALMT) for the radical correction of Congenital Heart Defects is an alternative to Median Sternotomy (MS) due to reduce operative trauma accelerating recovery and yield a better cosmetic outcome after surgery.Objectives: To conduct whether ALMT would bring more short-term benefits to patients than conventional Median Sternotomy by using a meta-analysis of case-control study in the published English Journal. Methods: 6 case control studies published in English from 1997 to 2011 were identified and synthesized to compare the short-term postoperative outcomes between ALMT and MS. These outcomes were cardiopulmonary bypass time, aortic cross-clamp time, Intubation's time, intensive care unit stay time, and postoperative hospital stay time. Results: ALMT had significantly longer cardiopulmonary bypass times (8.00 min more, 95% CI 0.36 to 15.64 min, p=0.04). Some evidence proved that aortic cross-clamp time of ALMT was longer, yet not significantly (2.38 min more, 95% CI -0.15 to 4.91 min, p=0.06). In addition, ALMT had significantly shorter Intubation's time (1.66 hrs less, 95% CI -3.05 to -0.27 hrs, p=0.02). Postoperative hospital stay time was significantly shorter with ALMT (1.52 days less, 95% CI -2.71 to -0.33 days, p=0.01). Some evidence suggested a reduction in ICU stay time in the ALMT group. However, this did not prove to be statistically significant (0.88 days less, 95% CI -0.81 to 0.04 days, p=0.08). Conclusion: ALMT can bring more benefits to patients with Congenital Heart Defects by reducing Intubation's time and postoperative hospital stay time, though ALMT has longer CPB time and aortic cross-clamp time.

Dissection of lung parenchyma using electrocautery is a safe and acceptable method for anatomical sublobar resection

Takashi Ohtsuka — 2012-05-03T00:00:00Z

Background: Anatomic sublobar resection is being assessed as a substitute to lobectomy for primary lung cancers. However, persistent air leak after anatomic sublobar resection is prevalent and increasing surgical morbidity and costs. The use of electrocautery is being popularized recently in anatomic sublobar resection. We have retrospectively evaluated the safety and efficacy of intersegmental plane dissection using electrocautery. Methods: Between April 2009 to September 2010, 47 patients were treated with segmentectomy for clinical T1N0M0 non-small cell lung cancers. The intersegmental plane was dissected using electrocautery alone or in combination with staplers. We evaluated the methods of dividing intersegmental plane (electrocautery alone or combination with electrocautery and staplers), intraoperative blood loss, duration of chest tube placement, duration of surgery, preoperative FEV1.0 %, incidence of prolonged air leak, length of postoperative hospital stay, postoperative pulmonary function at 6 months after surgery and the cost for sealing intersegmental plane. Results: Among the 47 patients, 22 patients underwent intersegmental plane dissection with electrocautery alone and 25 patients did in combination with electrocautery and staplers. The mean number of stapler cartridges used was only 1.3 in electrocautery and staplers group. Mean age, gender, number of patients whose FEV1% < 70 % were similar between two groups. There was no statistical difference between electrocautery alone and combination with electrocautery and staplers group in duration of surgery (282 vs. 290 minutes), intraoperative blood loss (203 vs.151 ml), duration of chest tube placement (3.2 vs. 3.1 days), postoperative hospital stay (11.0 vs.10.0 days), postoperative loss of FEV1.0 (13 vs.8 %), loss of FVC (11 vs. 6 %) or incidence of minor postoperative complications [9 % (2/22) vs. 16 % (4/25), p = 0.30)]. However, incidence of prolonged air leak was higher in electrocautery alone group than in combination with electrocautery and staplers group [14 % (3/22) vs. 4 % (1/25), p = 0.025)]. The cost of materials for sealing air leaks amounted to E964 per patient in the electrocautery alone group and E1594 per patient in combination with electrocautery and staplers group. Conclusions: The number of patients with prolonged air leak was higher in the electrocautery alone group. The use of staplers in addition to electrocautery may lead to reduced prolonged air leak. However, the use of electrocautery for intersegmental plane dissection appeared to be safe with acceptable postoperative complications and effective in reducing costs.

Aggressive treatment with noninvasive ventilation for mild acute hypoxemic respiratory failure after cardiovascular surgery: Retrospective observational study

Keiko Nakazato — 2012-05-03T00:00:00Z

Background: Acute hypoxemic respiratory failure (AHRF) is one of the most serious complications aftercardiovascular surgery. It remains unclear whether noninvasive ventilation (NIV) haspotential as an effective therapy for AHRF after cardiovascular surgery, although manyreports have described the use of NIV for AHRF after extubation. The aim of this study wasto investigate the effectiveness of NIV in the early stage of mild AHRF after cardiovascularsurgery. Methods: We retrospectively analyzed all patients admitted to the intensive care unit aftercardiovascular surgery, whose oxygenation transfer (PaO2/FIO2) deteriorated mildly afterextubation, and in whom NIV was initiated. A two-way analysis of variance and theBonferroni multiple comparisons procedure, the Mann-Whitney test, Fisher's exact test orthe chi2test was performed. Results: A total of 94 patients with AHRF received NIV, of whom 89 patients (94%) successfullyavoided endotracheal intubation (successful group) and five patients required reintubation(reintubation group). All patients, including the reintubated patients, were successfullyweaned from mechanical ventilation and discharged from the intensive care unit. In thesuccessful group, PaO2/FIO2 improved and the respiratory rate decreased significantly within1 h after the start of NIV, and the improvement in PaO2/FIO2 remained during the whole NIVperiod. Conclusion: We conclude that NIV is beneficial for mild AHRF after cardiovascular surgery when it isstarted within 3 h after mild deterioration of PaO2/FIO2. We also think that it is important notto hesitate before performing reintubation when NIV is judged to be ineffective.

Sternal reconstruction for unusual chondrosarcoma: innovative technique

Mario Nosotti — 2012-05-02T00:00:00Z

The authors report a clinical case of a primary sternal chondrosarcoma, presented as a mass inthe anterior mediastinum. The patient was treated with subtotal sternectomy and sternaltransplantation followed by radiotherapy. Twelve months after surgery, the patient is in goodclinical condition, without any sign of tumor relapse and with normal respiratory mechanics.Primary malignant tumors of the sternum are uncommon and a presentation mimickingthymoma is rare and unreported. The stermal replacement with a cryopreserved allograftsternum is an innovative technique that overcomes the problems related to the prostheticbiocompatibility or to the bone autograft.

Hemodynamic effects of peri-operative statin therapy in on-pump cardiac surgery patients

Jose Hinz — 2012-04-25T00:00:00Z

Background: Peri-operative statin therapy in cardiac surgery cases is reported to reduce the rate ofmortality, stroke, postoperative atrial fibrillation, and systemic inflammation. Systemicinflammation could affect the hemodynamic parameters and stability. We set out to study theeffect of statin therapy on perioperative hemodynamic parameters and its clinical outcome. Methods: In a single center study from 2006 to 2007, peri-operative hemodynamic parameters of 478patients, who underwent cardiac surgery with cardiopulmonary bypass, were measured.Patients were divided into those who received perioperative statin therapy (n = 276; statingroup) and those who did not receive statin therapy (n = 202; no-statin group). The twogroups were compared together using Kolmogorov-Smirnov-Test, Fisher's-Exact-Test, andStudent's-T-test. A p value < 0.05 was considered as significant. Results: There was no significant difference in the preoperative risk factors. Onset of postoperativeatrial fibrillation was not affected by statin therapy. Extended hemodynamic measurementsrevealed no significant difference between the two groups, apart from Systemic VascularResistance Index (SVRI) . The no-statin group had a significantly higher SVRI (882 +/- 206 vs.1050 +/- 501 dyn s/cm5/m2, p = 0.022). Inotropic support was the same in both groups and nosignificant difference in the mortality rate was noticed. Also, hemodynamic parameters werenot affected by different types and doses of statins. Conclusions: Perioperative statin therapy for patients undergoing on-pump coronary bypass grafting orvalvular surgery, does not affect the hemodynamic parameters and its clinical outcome.

Giant intercostal aneurysm complicated by Stanford type B acute aortic dissection in patients with type 1 neurofibromatosis

Takeshi Uzuka — 2012-04-24T00:00:00Z

Vascular involvement is rare in neurofibromatosis type 1 (NF1). It is often missed because it is usually asymptomatic. We report a case of a 42 years old male with neurofibromatosis type 1 who presented with left back discomfort. CT angiography revealed a massive 42 mm aneurysm of left 11th intercostal artery. After a discussion between radiologists and cardiothoracic surgeons, endovascular coil embolization was chosen to treat this patient. Percutaneous aneurysm embolization was successfully performed. However, the procedure was complicated by Stanford type B acute aortic dissection. Stanford type B acute aortic dissection was medically managed and patient remained well after discharge. Fragile vascular nature was thought to be one of the causes of this unreported complication.

Correction: first experience with a new negative pressure incision management system on surgical incisions after cardiac surgery in high risk patients

Andrea Colli — 2012-04-23T00:00:00Z

The first publication of the work [Colli A. J Cardiothorac Surg. 2011;6:160] did not present one of the authors' name. Maria-Luisa Camara has now been correctly added to the author list, and the Competing interests and Authors' contributions sections have been updated to reflect this.