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Pubblicazioni recenti - cardiac surgery
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Surgical Cytoreduction and HITOC for Thymic Malignancies with Pleural Dissemination.
Thorac Cardiovasc Surg2019 Nov;():. doi: 10.1055/s-0039-1700883.
Markowiak Till, Neu Reiner, Ansari Mohammed Khalid Afeen, Großer Christian, Klinkhammer-Schalke Monika, Hofmann Hans-Stefan, Ried Michael,
Abstract
BACKGROUND:
?Objective of this study was to assess postoperative morbidity and mortality as well as recurrence-free and overall survival in patients with thymic malignancies and pleural dissemination undergoing surgical cytoreduction and hyperthermic intrathoracic chemotherapy (HITOC).
METHODS:
?Retrospective study between September 2008 and December 2017 with follow-up analysis in May 2018.
RESULTS:
?A total of 29 patients (male: ?=?17) with thymic malignancies and pleural spread (primary stage IVa: ?=?11; pleural recurrence: ?=?18) were included. Surgical cytoreduction was performed via pleurectomy/decortication (P/D; ?=?11), extended P/D (?=?15), and extrapleural pneumonectomy (EPP; ?=?3). These procedures resulted in 25 (86%) patients with macroscopically complete (R0/R1) resection. Intraoperative HITOC was performed for 60?minutes at 42°C either with cisplatin (100?mg/m body surface area [BSA] ?=?8; 150?mg/m BSA ?=?6; 175?mg/m BSA ?=?1) or with a combination of cisplatin (175?mg/m BSA)/doxorubicin (65?mg; ?=?14). Postoperative complications occurred in nine patients (31%). Cytoprotective therapy resulted in lower postoperative creatinine levels (?=?0.036), and there was no need for temporary dialysis in these patients. The 90-day mortality rate was 3.4%, as one patient developed multiple organ failure. While recurrence-free 5-year survival was 54%, an overall 5-year survival rate of 80.1% was observed. Survival depended on histological subtype (?=?0.01).
CONCLUSION:
?Surgical cytoreduction with HITOC is feasible in selected patients and offers encouraging survival rates. The application of cytoprotective agents appears to be effective for the prevention of postoperative renal insufficiency.
Georg Thieme Verlag KG Stuttgart · New York.
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Midterm Outcomes of Surgical Repair of Partial Anomalous Pulmonary Venous Connection to SVC.
Thorac Cardiovasc Surg2019 Nov;():. doi: 10.1055/s-0039-1700882.
Hu Jie, Hu Renjie, Zhang Haibo, Zhang Lei, Zhang Wen, Chen Dian, Dong Wei,
Abstract
OBJECTIVES:
?We explore midterm results after surgical treatment of partial anomalous pulmonary venous connection (PAPVC) to superior vena cava (SVC) in our institution.
METHODS:
?From 2008 to 2017, 78 patients underwent surgical repair for PAPVC to SVC. Patients were divided into three groups based on surgical techniques: Single-patch repair (?=?20, group A), double-patch repair (?=?31, group B), and Warden repair (?=?27, group C). Their median age was 1.9 years (range: 3 months-13.8 years); median weight was 11.4?kg (range: 4.4-39.7?kg). Clinical, electrocardiographic and echocardiographic were available for all patients.
RESULTS:
?There were no early or late mortality. The mean follow-up duration was 1.8?±?2.1 years (range: 0.6 months to 8 years). No pulmonary venous obstruction occurred and no residual left-to-right shunts sustained during the follow-up. Reoperation for SVC obstruction was required: 1 (5.3%) in group A, 1 (3.2%) in group B, and 2 (7.4%) in group C (?=?0.78). Four patients (3 in group B, 1 in group C, ?=?0.7) presented transient rhythm disturbance at discharge and one patient in group B remains nonsinus rhythm during follow-up. Pacemaker was not required in all patients.
CONCLUSION:
?PAPVC to SVC can be safely managed by multiple techniques. Careful manipulation nearby sinus node must be emphasized during double-patch repair to prevent injury of sinus node. Obstruction of postoperative SVC stenosis should be paid attention to after Warden procedure. For young patients, operation should not be performed that early, but until preschool age.
Georg Thieme Verlag KG Stuttgart · New York.
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The morphology of cervical deformities: a two-step cluster analysis to identify cervical deformity patterns.
J Neurosurg Spine2019 Nov;():1-7. doi: 10.3171/2019.9.SPINE19730.
Kim Han Jo, Virk Sohrab, Elysee Jonathan, Passias Peter, Ames Christopher, Shaffrey Christopher I, Mundis Gregory, Protopsaltis Themistocles, Gupta Munish, Klineberg Eric, Smith Justin S, Burton Douglas, Schwab Frank, Lafage Virginie, Lafage Renaud, ,
Abstract
OBJECTIVE:
Cervical deformity (CD) is difficult to define due to the high variability in normal cervical alignment based on postural- and thoracolumbar-driven changes to cervical alignment. The purpose of this study was to identify whether patterns of sagittal deformity could be established based on neutral and dynamic alignment, as shown on radiographs.
METHODS:
This study is a retrospective review of a prospective, multicenter database of CD patients who underwent surgery from 2013 to 2015. Their radiographs were reviewed by 12 individuals using a consensus-based method to identify severe sagittal CD. Radiographic parameters correlating with health-related quality of life were introduced in a two-step cluster analysis (a combination of hierarchical cluster and k-means cluster) to identify patterns of sagittal deformity. A comparison of lateral and lateral extension radiographs between clusters was performed using an ANOVA in a post hoc analysis.
RESULTS:
Overall, 75 patients were identified as having severe CD due to sagittal malalignment, and they formed the basis of this study. Their mean age was 64 years, their body mass index was 29 kg/m2, and 66% were female. There were significant correlations between focal alignment/flexibility of maximum kyphosis, cervical lordosis, and thoracic slope minus cervical lordosis (TS-CL) flexibility (r = 0.27, 0.31, and -0.36, respectively). Cluster analysis revealed 3 distinct groups based on alignment and flexibility. Group 1 (a pattern involving a flat neck with lack of compensation) had a large TS-CL mismatch despite flexibility in cervical lordosis; group 2 (a pattern involving focal deformity) had focal kyphosis between 2 adjacent levels but no large regional cervical kyphosis under the setting of a low T1 slope (T1S); and group 3 (a pattern involving a cervicothoracic deformity) had a very large T1S with a compensatory hyperlordosis of the cervical spine.
CONCLUSIONS:
Three distinct patterns of CD were identified in this cohort: flat neck, focal deformity, and cervicothoracic deformity. One key element to understanding the difference between these groups was the alignment seen on extension radiographs. This information is a first step in developing a classification system that can guide the surgical treatment for CD and the choice of fusion level.
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Medical Event Management for Future Deep Space Exploration Missions to Mars.
J Surg Res2019 Nov;246():305-314. doi: S0022-4804(19)30710-3.
Robertson Jamie M, Dias Roger D, Gupta Avni, Marshburn Thomas, Lipsitz Stuart R, Pozner Charles N, Doyle Thomas E, Smink Douglas S, Musson David M, Yule Steven,
Abstract
BACKGROUND:
Long-duration exploration missions (LDEMs), such as voyages to Mars, will present unique medical challenges for astronaut crews, including communication delays and the inability to return to Earth early. Medical events threaten crewmember lives and increase the risk of mission failure. Managing a range of potential medical events will require excellent technical and nontechnical skills (NTSs). We sought to identify medical events with potential for rescue, range them according to the potential impact on crew health and mission success during LDEMs, and develop a list of NTSs to train for management of in-flight medical events.
MATERIALS AND METHODS:
Twenty-eight subject matter experts with specializations in surgery, medicine, trauma, spaceflight operations, NTS training, simulation, human factors, and organizational psychology completed online surveys followed by a 2-d in-person workshop. They identified and rated medical events for survivability, mission impact, and impact of crewmember NTSs on outcomes in space.
RESULTS:
Sudden cardiac arrest, smoke inhalation, toxic exposure, seizure, and penetrating eye injury emerged as events with the highest potential mission impact, greatest potential for survival, and that required excellent NTS for successful management. Key NTS identified to target in training included information exchange, supporting behavior, communication delivery, and team leadership/followership.
CONCLUSIONS:
With a planned Mars mission on the horizon, training countermeasures need to be developed in the next 3-5 y. These results may inform policy, selection, medical system design, and training scenarios for astronauts to manage in-flight medical events on LDEMs. Findings may extend to surgical and medical care in any rural and remote location.
Copyright © 2019. Published by Elsevier Inc.
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Simulated microgravity-cultured mesenchymal stem cells improve recovery following spinal cord ischemia in rats.
Stem Cell Res2019 Oct;41():101601. doi: S1873-5061(19)30231-4.
Kurose Tomoyuki, Takahashi Shinya, Otsuka Takashi, Nakagawa Kei, Imura Takeshi, Sueda Taijiro, Yuge Louis,
Abstract
Spinal cord ischemia is a potential complication of thoracoabdominal aortic surgery that may induce irreversible motor disability. We investigated the therapeutic efficacy of simulated microgravity-cultured mesenchymal stem cell (MSC) injection following spinal cord ischemia-reperfusion injury. Sprague-Dawley rats were divided into sham, phosphate-buffered saline (PBS), normal gravity-cultured MSC (MSC-1 G), and simulated microgravity-cultured MSC (MSC-MG) groups. Spinal cord ischemia was induced by transient balloon occlusion of the thoracic aorta, which was followed immediately by PBS or MSC injection into the left carotid artery. Hindlimb motor function was evaluated by the Basso-Beattie-Bresnahan (BBB) scale. Spinal cords were removed 1, 3, or 7 days post-injury for immunohistochemical staining and Western blot analysis. One day post-injury, a few infiltrating inflammatory cells and small vacuoles were observed without significant group differences, followed over several days by progressive spinal cord degeneration. Glial fibrillary acidic protein (GFAP)-positive (reactive) astrocyte numbers were increased in all three groups, and brain-derived neurotrophic factor (BDNF) was colocalized with GFAP-positive cells in spinal ventral horn. Animals in the MSC-MG group demonstrated greater BDNF-positive astrocyte numbers, reduced caspase-3-positive cell numbers, and superior motor recovery. Microgravity-cultured MSC-based therapy may improve functional recovery following spinal ischemia-reperfusion injury by promoting astrocytic BDNF release, thereby preventing apoptosis.
Copyright © 2019 The Author(s). Published by Elsevier B.V. All rights reserved.
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The IASLC Lung Cancer Staging Project: Analysis of Resection Margin Status and Proposals for Residual Tumor (R) Descriptors for Non-Small Cell Lung Cancer.
J Thorac Oncol2019 Nov;():. doi: S1556-0864(19)33637-8.
Edwards John G, Chansky Kari, van Schil Paul, Nicholson Andrew G, Boubia Souheil, Brambilla Elisabeth, Donnington Jessica, Galateau-Sallé Françoise, Hoffman Hans, Infante Maurizio, Marino Mirella, Marom Edith, Nakajima Jun, Ostrowski Marcin, Travis William D, Tsao Ming S, Yatabe Yasushi, Giroux Dorothy J, Shemanski Lynn, Crowley John, Krasnik Marc, Asamura Hisao, Rami-Porta Ramón, ,
Abstract
INTRODUCTION:
To validate the prognostic relevance in NSCLC of potential residual tumor (R) descriptors, including the proposed International Association for the Study of Lung Cancer definition for uncertain resection -R(un).
METHODS:
14,712 patients undergoing resection with full R status and survival were analyzed. The following were also evaluated: <3 N2 stations explored; lobe-specific nodal dissection (LSND); extra-capsular extension (ECE); highest lymph node station status; carcinoma in situ at bronchial resection margin (BRMcis); pleural lavage cytology (PLC). Revised categories of R0, R(un), R1 and R2 were tested for survival impact.
RESULTS:
14,293 cases were R0, 263 R1 and 156 R2 (median survival: not reached, 33, 29 months, respectively). R status correlated with T and N categories. 9,290 (63%) cases had ?3 N2 stations explored and 6,641 (45%) had LSND, correlated with increasing pN2. ECE was present in 62 (17%) of 364 cases with available data. The highest station was positive in 942 (6.4%). PLC was positive in 59 (3.5%) of 1,705 cases: 13 had BRMcis. After reassignment, due to inadequate nodal staging in 56%, 6,070 cases were R0, 8,185 R(un), 301 R1 and 156 R2. In node positive cases, median survival was 70, 50, 30 months for R0, R(un), (p<0.0001) and R1 (p<0.001), respectively, with no significant difference between R0 and R(un) in pN0 cases.
CONCLUSIONS:
R descriptors have prognostic relevance with R(un) survival stratifying between R0 and R1. Therefore, a detailed evaluation of R factor is of particular importance in the design and analyses of clinical trials of adjuvant therapies.
Copyright © 2019 International Association for the Study of Lung Cancer. All rights reserved.
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Does Increasing Age Impact Clinical and Radiographic Outcomes Following Lumbar Spinal Fusion?
Spine J2019 Nov;():. doi: S1529-9430(19)31071-X.
Khan Jannat M, Basques Bryce A, Harada Garrett K, Louie Philip K, Chen Ian, Vetter Christian, Kadakia Karishma, Elboghdady Islam, Colman Matthew, An Howard S,
Abstract
BACKGROUND CONTEXT:
Despite the growing senior population within the United States, there is a lack of consensus regarding the safety and efficacy of performing lumbar spinal fusion for this population.
PURPOSE:
To evaluate the clinical and radiographic outcomes in different age cohorts following lumbar spinal fusion.
STUDY DESIGN:
Retrospective cohort analysis PATIENT SAMPLE: Analysis of 1184 patients who underwent posterolateral lumbar fusion from 2011 to 2018. Surgery was indicated after failure of conservative treatment to address radiculopathy and/or neurogenic claudication. Patients were excluded if they were under 18 years of age at the time of surgery, had a lumbar fracture, tumor, or infection, or had fusions involving the thoracic spine, high-grade spondylolisthesis, or concomitant deformity. Of the 1184 patients, 850 patients were included. Patients were divided into three roughly equal groups for analysis: young (18-54 years), middle-aged (55-69 years), and senior (?70 years).
OUTCOME MEASURES:
Visual Analog Scale Back/Leg pain, and Oswestry Disability Index (ODI) were collected, and achievement of minimal clinically important difference was evaluated. Lumbar lordosis (LL), pelvic tilt (PT), pelvic incidence (PI), and PI-LL difference were measured on radiographs. Rates of postoperative complications were analyzed.
METHODS:
Several radiographic parameters were measured using plain radiographs obtained at preoperative, immediately postoperative (standing radiographs performed on postoperative day 1), and most recent follow-up visits. Preoperative and final patient reported outcomes, along with demographic information, were obtained all patients. Binary outcome variables were compared between groups with multivariate logistic regression, and continuous outcome variables were compared using multivariate linear regression, with age 18-54 years used as the reference. Multivariate regressions were used to compare outcomes between cohorts while controlling baseline characteristics.
RESULTS:
850 patients were included; 330 (38.80%) young, 317 (37.30%) middle-aged, and 203 senior (23.90%). Seniors had higher postoperative length of stay compared to younger patients (p<0.001). Younger patients had worse final ODI scores compared to middle-aged patients (p=0.002). Seniors had higher rates of proximal ASD (p=0.002) compared to young patients. There was no difference in achievement of minimal clinically important differences (MCID) between all three groups.
CONCLUSIONS:
Senior patients have significant improvement in patient-reported clinical outcomes, despite having greater comorbidities, and longer length of stay. However, given a general lack of achievement of MCID across all cohorts, these findings suggest the need for a critical reevaluation of the role of lumbar spinal fusion in the management of patients with refractory radiculopathic and/or neurogenic claudication symptoms.
Copyright © 2019. Published by Elsevier Inc.
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Viral Infection Increases the Risk of Idiopathic Pulmonary Fibrosis: A Meta-analysis.
Chest2019 Nov;():. doi: S0012-3692(19)34200-X.
Sheng Gaohong, Chen Peng, Wei Yanqiu, Yue Huihui, Chu Jiaojiao, Zhao Jianping, Wang Yihua, Zhang Wanguang, Zhang Hui-Lan,
Abstract
BACKGROUND:
Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive, fibrotic lung disease with a poor prognosis. Although many factors have been identified to possibly trigger or aggravate IPF, such as viral infection, the exact etiology of IPF remains unclear. Until now, there has been no systematic review to quantitatively assess the role of viral infection in IPF.
OBJECTIVE:
This meta-analysis aims to present a collective view on the relationship between viral infection and IPF.
METHODS:
We searched studies reporting the effect of viral infection on IPF from Pubmed, Embase, Cochrane Library, Web of Science, and Wiley Online Library databases. The value of OR with 95% CI was calculated to assess the risk of virus in IPF. We also estimated statistical heterogeneity by I and Cochran Q test, publication bias by funnel plot, Begg's test, Egger's test and trim and fill method. Regression, sensitivity and subgroup analyses were performed to assess the effects of confounding factors, such as gender and age.
RESULTS:
We analyzed 20 case-control studies with 1287 participants from 10 countries. The pooled OR of all viruses indicated that viral infection could significantly increase the risk of IPF (OR: 3.48, 95% CI: 1.61-7.52, p=0.001), but not that of exacerbation of IPF (OR: 0.99, 95% CI: 0.46-2.12, p=0.988). In addition, all analyzed viruses including Epstein-Barr virus (EBV), cytomegalovirus (CMV), human herpesvirus 7 (HHV7) and human herpesvirus 8 (HHV8) were associated with a significant elevation in the risk of IPF, except human herpesvirus 6 (HHV6).
CONCLUSIONS:
The presence of persistent or chronic, but not acute, viral infections including EBV, CMV, HHV7 and HHV8, significantly increases the risk of developing IPF, but not exacerbation of IPF. These findings imply that viral infection could be a potential risk factor for IPF.
Copyright © 2019. Published by Elsevier Inc.
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Increasing donor sequence number is not associated with inferior outcomes in lung transplantation.
J Card Surg2019 Nov;():. doi: 10.1111/jocs.14343.
Axtell Andrea L, Moonsamy Philicia, Melnitchouk Serguei, Tolis George, D'Alessandro David A, Villavicencio Mauricio A,
Abstract
BACKGROUND:
Donor sequence number (DSN) represents the number of recipients to whom an organ has been offered. The impact of seeing numerous prior refusals may potentially influence the decision to accept an organ. We sought to determine if DSN was associated with inferior posttransplant outcomes.
METHODS:
Using the United Network for Organ Sharing database, a retrospective analysis was performed on 22?361 patients who received a lung transplant between 2005 and 2017. Patients were grouped into low DSN (1-24, n?=?16?860) and high DSN (>24, n?=?5501) categories. Baseline characteristics and posttransplant outcomes were analyzed. An institutional subgroup was also analyzed to compare rates of primary graft dysfunction (PGD) posttransplant.
RESULTS:
The DSN ranged from 1 to 1735 (median, 7; interquartile range, 2-24). A total of 18?507 recipients received an organ with at least one prior refusal. Recipients of donors with a higher DSN were older (58 vs 55 years; P?50 and >75 also demonstrated no difference in mortality when compared with a low DSN (P?=?.86 and P?=?.97). There was no difference in PGD for patients with a low vs a high DSN at any time posttransplant.
CONCLUSIONS:
DSN is not associated with increased mortality in patients undergoing lung transplantation and should not negatively influence the decision to accept a lung for transplant.
© 2019 Wiley Periodicals, Inc.
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In vivo comparison of the optiflow and EZ glide aortic dispersion cannulas.
J Card Surg2019 Nov;():. doi: 10.1111/jocs.14347.
Gennari Marco, Rossi Fabiana, Polvani Gianluca, Bertera Antonella, Riva Gianluca, Fave Antonella D, Rassiga Cecilia, Agrifoglio Marco,
Abstract
OBJECTIVES:
Morbidity associated with coronary artery bypass grafts and embolization during aortic cannulation is strongly related to patient characteristics/comorbidities, arterial cannulation site used and the shape of arterial cannulae tips. The desired features of an arterial cannula should be to mitigate the morbid effects of these cannulas and to focus on achieving higher blood flows with lower cannula pressures (CPs).
MATERIALS AND METHODS:
To evaluate the in vivo performance of two aortic dispersion flow cannulas: the Optiflow (Sorin Group, Italy) and EZ Glide (Edwards Lifesciences). They were evaluated for CPs, pump-flow rates (FRs), and plasma-free hemoglobin (Hb) over a 12-month period. Data were collected in a prospective, randomized (1:1), nonblinded, monocentric study with a cohort of 30 patients (optiflow group N?=?15; EZ Glide group N?=?15).
RESULTS:
The optiflow cannula was found to have decreasing CPs as the pump FRs were increased (112.3?±?10.9 vs 131.1?±?11.4?mm?Hg; P?
CONCLUSIONS:
Both optiflow and EZ Glide dispersion flow arterial cannulas performed well, but the optiflow cannula demonstrated an ability to increase pump FRs with lower arterial line and CPs than the EZ Glide cannula. This implies an ability to improve peripheral perfusion while reducing cannula shear stress and the risk of endothelial damage, thereby having the potential to reduce the risk of atherosclerotic plaque dislodgement.
© 2019 Wiley Periodicals, Inc.
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Neoangiogenesis connecting a left internal mammary artery proximal stump to an ischemic area of the heart after bypass occlusion.
J Card Surg2019 Nov;():. doi: 10.1111/jocs.14353.
Picichè Marco, Versaci Francesco,
Abstract
Internal mammary arteries (IMAs), via angiogenesis/arteriogenesis, have great potential for developing collaterals. This generally occurs when ischemia involves the inferior limbs or heart. Although this phenomenon may be spontaneous, it seems to be promoted by iatrogenic or voluntary occlusion of the IMAs. We present a patient who underwent triple coronary artery bypass grafting with two saphenous vein grafts and a free-graft left IMA and suffered an acute myocardial infarction 6 weeks after surgery. Emergency coronary angiography revealed occlusion of the grafts and an amazing branch arising from the proximal stump of the surgically-cut and clipped IMA, leading to the anterior wall of the heart, functionally creating an effective natural bypass, probably stimulated both by anterior wall ischemia and interrupted flow within the proximal left IMA.
© 2019 Wiley Periodicals, Inc.
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Myocardial infarction revealed a giant right coronary artery aneurysm.
J Card Surg2019 Nov;():. doi: 10.1111/jocs.14357.
Mimbimi Chloe, Hajj-Chahine Jamil, Allain Géraldine, Jayle Christophe, Corbi Pierre,
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Risk stratification for nonagenarians undergoing transcatheter aortic valve replacement.
J Card Surg2019 Nov;():. doi: 10.1111/jocs.14350.
Yu Pey-Jen, Catalano Michael, Palazzo Robert, Cassiere Hugh, Kohn Nina, Rutkin Bruce, Maurer Greg, Berg Jacinda A, Hartman Alan,
Abstract
BACKGROUND:
There are disparate data on the outcomes of nonagenarians undergoing transcatheter aortic valve replacement (TAVR) compared with younger patients. The purpose of this study is to determine whether the Society of Thoracic Surgeons (STS) score can be used to identify the subset of nonagenarians that are at a significantly higher risk for poor postoperative outcomes after TAVR.
METHODS:
A total of 425 patients above the age of 80 underwent elective TAVR between 12/2013 and 2/2018 and were included in this study. Patients were deemed intermediate or high risk based on an STS predicted the risk of surgical mortality score of 3% to 8% and more than 8%, respectively. Differences in postoperative outcomes and/or 6-month mortality between intermediate and high-risk octogenarians and nonagenarians were compared.
RESULTS:
Of the 425 patients, 112 (26.4%) patients were nonagenarians, and 313 (73.6%) patients were octogenarians. Fifty-four (48.2%) of the nonagenarians were stratified as high-risk, while 78 (24.9%) of the octogenarians were stratified as high-risk. There were no statistically significant differences in the composite outcomes between intermediate-risk nonagenarians and intermediate-risk octogenarians. In contrast, high-risk nonagenarians were significantly more likely to experience the composite outcome of major perioperative complications and/or 6-month mortality as compared to high-risk octogenarians.
CONCLUSION:
Intermediate-risk nonagenarians undergoing TAVR have similar postoperative outcomes compared to intermediate-risk octogenarians. However, high-risk nonagenarian patients undergoing TAVR experience significantly poorer outcomes compared to their octogenarian counterparts. Judicious patient selection for TAVR in this subgroup of patients is therefore warranted.
© 2019 Wiley Periodicals, Inc.
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Combined off-pump coronary bypass grafting without heparin and liver transplantation: A novel approach to a complex dilemma.
J Card Surg2019 Nov;():. doi: 10.1111/jocs.14344.
Brozzi Nicolas A, Beduschi Thiago, Salerno Tomas, Cifuentes Renzo, Ghodsizad Ali, Martin Eric, Vianna Rodrigo, Loebe Matthias,
Abstract
Cardiac disease is a leading cause of early mortality for patients undergoing liver transplantation (LT), and severe coronary artery disease (CAD) is usually considered a contraindication for LT in patients with cirrhosis. Incidence of CAD in LT candidates has increased in recent years. While stable patients might be candidates for percutaneous interventions, patients with decompensated liver failure, or critical coronary lesions present a therapeutic challenge, and are often not considered candidates for LT. We present the case of a 60 year old male patient with decompensated liver failure, and critical CAD, who received successful combined off-pump coronary bypass grafting without heparin and LT using ex vivo normothermic liver perfusion machine. This approach represents a novel strategy to offer LT to this very selective group of patients.
© 2019 Wiley Periodicals, Inc.
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Severely calcified bicuspid aortic valve stenosis after valve-sparing root replacement: A word of caution.
J Card Surg2019 Nov;():. doi: 10.1111/jocs.14348.
Fukunaga Naoto, Butany Jagdish, Feindel Christopher M,
Abstract
A 58-year-old man was admitted for reoperation for severe aortic stenosis in a previously preserved bicuspid aortic valve (BAV). He had undergone valve-sparing root replacement (VSSR) for dilated aortic root 6 years ago. Transesophageal echocardiography following VSSR showed good valve function with no aortic incompetence. However, the BAV became stenotic causing shortness of breath. At reoperation, the preserved BAV was noted to be fibrotic and calcified and had a fixed rigid small orifice. It was replaced with a biological valve plus root enlargement. Macroscopic finding showed thickening of the cusps and nodular calcification. Microscopic examination revealed severe nodular calcification.
© 2019 Wiley Periodicals, Inc.
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Excess nonhemorrhagic pleural drainage after surgery for congenital heart diseases: Single center experience.
J Card Surg2019 Nov;():. doi: 10.1111/jocs.14338.
Elassal Ahmed A, Al-Radi Osman O, Dohain Ahmed M, Abdelmohsen Gaser A, Al-Ebrahim Khalid E, Eldib Osama S,
Abstract
OBJECTIVE:
Chylothorax after surgery for congenital heart disease is an uncommon but serious complication that adversely affects surgical outcomes. The aim of our study was presenting our experience for the management of postoperative chylothorax and excess nonhemorrhagic pleural drainage.
METHODS:
Medical records of patients with excess nonhemorrhagic pleural drainage were retrospectively reviewed and the collected data included demographics, surgical procedures, drainage characteristics, methods of postoperative management, and outcome.
RESULTS:
From March 2011 to May 2018, 52 patients with excess postoperative pleural drainage were identified from a total of 816 pediatric patients operated upon for congenital cardiac disease, giving an incidence of 63.7%. Tetralogy of Fallot and single ventricle morphology were the most common cardiac pathology. The serum triglyceride level was checked and found elevated in 30 patients (53.5%). The maximum daily drainage was 136.25?±?109.7?mL/day and the mean duration of drainage was 32.23?±?35.7 days. Medium-chain triglyceride formula was given for 27 patients (51.9%), octreotide for 22 (42.3%) for a mean duration of 8.07?±?28.3 days. Total parenteral nutrition was needed for 11 patients (21.1%) for a mean duration of 3.13?±?7.63 days. The success rate for conservative management was 94.2%. Thoracic duct ligation performed for three patients. The mean duration of mechanical ventilation was 7.4?±?3.6 days, mean intensive care unit stay was 29.6?±?35.1 days, and mean total hospital stay was 20.9?±?17.5 days. We had six cases of hospital mortality (11.53%).
CONCLUSION:
Initiation of a stepwise approach for excess nonhemorrhagic pleural drainage based on the amount and rate of drainage achieve a favorable outcomes.
© 2019 Wiley Periodicals, Inc.
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"Atrial fibrillation as initial symptom of an intrapericardial bronchogenic cyst".
J Card Surg2019 Nov;():. doi: 10.1111/jocs.14356.
Kotoulas Christophoros, Georgiou Charalampos, Grapatsas Konstantinos, Kotoulas Sotirios, Kagialaris Georgios, Panagiotou Ioannis,
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Combined treatment (image-guided thrombectomy and endovascular therapy with open femoral access) for acute lower limb ischemia: Clinical efficacy and outcomes.
PLoS One2019 ;14(11):e0225136. doi: 10.1371/journal.pone.0225136.
Cho Soo Buem, Choi Ho Cheol, Lee Sang Min, Na Jae Boem, Park Mi Jung, Shin Hwa Seon, Won Jung Ho, Lee Chung Eun, Park Sung Eun,
Abstract
OBJECTIVES:
To evaluate the effectiveness and safety of combined treatment (image guided thrombectomy and endovascular therapy with open femoral access) for acute lower limb ischemia.
METHODS:
From 2009 to 2017, 52 patients (44 men, eight women, mean 67.2 years) underwent combined treatment for acute thrombotic occlusion of lower extremity arteries. The patients presented with acute limb ischemia and we selectively perform combined treatment in the cases with challenging clinical considerations (e.g. various spectrum of thrombus, underlying atherosclerotic lesions). Combined treatment included cutdown of common femoral artery, thrombectomy using a Fogarty balloon catheter, balloon angioplasty, stenting, and catheter-introduced thrombus fragmentation and aspiration. Patients' medical records were retrospectively reviewed and follow-up data were collected. The technical and clinical success rates and limb salvage were assessed. The Kaplan-Meier method was used to analyze primary patency rates and overall survival rates. Univariate analyses were performed to determine the factors related to clinical outcomes.
RESULTS:
Technical and clinical success rate was 90.4% and 80.8%, respectively. The mean follow-up duration was 26.5 ± 25.8 months. Primary patency was 91.4%, 86.1%, and 74.6% at six months, 1-, and 2-year, respectively. Limb salvage without amputation was 88.5% (46/52). The overall survival rates at six months, 1-, and 3-year were 82.6%, 80.2, and 56.9%, respectively. The 30-day mortality was 5.8% (3/52). Univariate analysis showed that percutaneous transluminal angioplasty (PTA) type (balloon versus stent) was related to clinical failure.
CONCLUSIONS:
Combined treatment can be effective and safe for ALI patients even under challenging clinical conditions.
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3D echocardiography allows rapid and accurate surgical planning in complex aortic root abscess cases.
Echo Res Pract2019 Oct;():. doi: 10.1530/ERP-19-0043.
Ahluwalia Viren, Osman Faizel, Parmar Jitendra, Khan Jamal Nasir,
Abstract
Despite 3D echocardiography (3DE) acquiring significantly greater data than standard 2D echocardiography (2DE), it is underutilized in assessing cardiac anatomy and physiology. A key advantage is the ability of a single 3DE acquisition to be post-processed to generate volume rendered 3D models and an unlimited number of multiplanar reconstruction (MPR) images. We describe the case of a highly anxious patient with life-threatening complex aortic valve endocarditis and aortic root abscess, refusing transesophageal echocardiography (TOE) under general anaesthesia with tachycardia, breathlessness and acute kidney injury precluding accurate or safe gated (computed tomography) CT, who was comprehensively assessed with a rapid 3DE-TOE under sedation. This led to timely surgery and an excellent outcome for the patient.
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MicroRNA-326-5p enhances therapeutic potential of endothelial progenitor cells for myocardial infarction.
Stem Cell Res Ther2019 Nov;10(1):323. doi: 10.1186/s13287-019-1413-8.
Li Xiaoting, Xue Xiang, Sun Yuejun, Chen Lei, Zhao Ting, Yang Wentao, Chen Yongbing, Zhang Zhiwei,
Abstract
BACKGROUND:
Our study sought to investigate the therapeutic effects and mechanisms of miR-326-5p-overexpressing endothelial progenitor cells (EPCs) on acute myocardial infarction (AMI).
METHODS:
Mouse EPCs were isolated, purified, and identified by flow cytometry and uptake of DiI-ac-LDL. The target gene of miR-326-5p was predicted using target prediction algorithms and verified by dual-luciferase reporter assay, RT-qPCR, and Western blot. After EPCs were transfected with the agomir or antagomir of miR-326-5p, tube formation assay and Matrigel plug angiogenesis assay were conducted in four groups (NC, miR-326-5p agomir, miR-326-5p antagomir, and miR-326-5p agomir+Wnt1 agonist). In addition, a mouse model of MI was established and treated with the injection of miR-326-5p-EPCs, miR-326-5p-EPCs+ Wnt1 agonist, EPCs-NC, or PBS/control into the peri-infarcted myocardium. Subsequently, cardiac function was monitored by echocardiography at 7 and 28?days postoperatively. Finally, the infarcted hearts were collected at 28?days, and the size of myocardial infarction was measured by Masson's trichrome staining and the neovascularization in the peri-infarcted area was examined through immunofluorescence staining.
RESULTS:
Luciferase reporter assay indicated that Wnt1 was a direct target of miR-326-5p. Using RT-qPCR and Western blot analysis, we further demonstrated that the expression level of Wnt1 was negatively correlated with miR-326-5p expression in EPCs. Both in vitro study of tube formation assay and in vivo investigation of subcutaneous Matrigel plug assay revealed that the miR-326-5p agomir could significantly enhance the angiogenic capacity of EPCs, and this effect was partially inhibited by Wnt1 agonist. Meanwhile, miR-326-5p antagomir could obviously reduce the the angiogenic capacity of EPCs in vivo compared with that in the NC group. Moreover, the transplantation of miR-326-5p-overexpressing EPCs in the ischemic hearts of mice significantly enhanced the angiogenesis in the peri-infarcted zone and improved the cardiac function. However, the enhanced capacity of angiogenesis of miR-326-5p-overexpressing EPCs was remarkably neutralized by Wnt1 agonist, accompanied by the decreased improvement in cardiac function.
CONCLUSION:
miR-326-5p significantly enhanced the angiogenic capacity of EPCs. Transplantation of miR-326-5p-overexpressing EPCs improved cardiac function for AMI therapy, which can be a novel strategy for enhancing therapeutic angiogenesis in ischemic heart diseases.
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