American Journal of Cardiovascular and Thoracic Surgery最新文献

{"title":"VA-ECMO and VV-ECMO in COVID-19: Severe ARDS or Cardiogenic Shock?","authors":"F. Gatta, C. Evans, N. Lazarus","doi":"10.15226/2573-864x/5/2/00169","DOIUrl":"https://doi.org/10.15226/2573-864x/5/2/00169","url":null,"abstract":"The novel coronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in Wuhan, China, on December 2019. Since then it has spread worldwide, causing an unforeseen global crisis. Respiratory involvement ranging from a mild flu-like illness to potentially lethal acute respiratory distress syndrome (ARDS) is the predominant clinical manifestation of SARS-CoV-2. However, cardiovascular complications can also result in severe morbidity and mortality. Although ARDS appears to be the most common trigger for intensive care unit (ICU) admission, cardiac injury and shock are also frequent. In patients with ARDS and/or cardiogenic shock, the Extracorporeal Membrane Oxygenation (ECMO) is often required to provide respiratory and cardiac support. Nevertheless, evidence on ECMO in COVID-19 patients remains controversial. This review sought to analyse the use of veno-venous-ECMO and veno-arterial-ECMO in SARS-CoV-2 positive patients, of whom age (p-value 0.89), previous medical history, presenting complaints, echocardiography, indication for ECMO, duration of support (p-value0.31), and status at discharge (mortality p-value0.75) were analysed. It has to be acknowledged that a multidisciplinary approach and a frequent reassessment of response to mechanical circulatory support are fundamental for the SARS-CoV-2 population requiring cardiac and/or respiratory support. Keywords: VA-ECMO;VV-ECMO;ECLS;COVID-19;SARS-CoV-2;cardiogenic shock;ARDS","PeriodicalId":362247,"journal":{"name":"American Journal of Cardiovascular and Thoracic Surgery","volume":"16 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115377722","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lower Mini-Sternotomy: a New Approach for Minimally Coronary Artery Bypass Surgery: Chances and Limitations of a New Technology","authors":"I. Martinovic, Lucija Martinovic, A. Včev, Luka Malenica, T. Wittlinger","doi":"10.15226/2573-864x/5/2/00168","DOIUrl":"https://doi.org/10.15226/2573-864x/5/2/00168","url":null,"abstract":"Background The rate of Coronary Artery Bypass Grafting (CABG) procedures decreased generally over the past years while the relative number of off-pump coronary artery bypass grafting (OPCAB) procedures remained stable. OPCAB can be performed in different ways also using a minimally invasive direct approach (MIDCAB). This technique consists usually of the approach through the Left Anterior Small Thoracotomy (LAST) and is in principle limited for single LAD revascularization only. Lower Mini-Sternotomy (LOMS) is an optimization of the minimal-invasive approach permitting the harvest of both internal thoracic arteries (ITA) as well as excellent exposure and immobilization of the left and right coronary arteries. Methods Between January 2016 and June 2017 LOMS was performed in 31 patients to achieve access to the left and right internal thoracic arteries and to reach the left anterior descending coronary artery, diagonal branches, and right coronary artery for off-pump, all-arterial, aortic no-touch revascularization. Postoperative pain intensity was assessed on a daily basis for 7 days and patients were followed prospectively after operation at our outpatient clinic on a monthly basis in order to assess the incidence of complications. Results The mean operative time was 163 ± 49 minutes (range 119 to 260 minutes). The mean length of the skin incision was 7.4 ± 1.3 cm (range 6 to 11 cm). Neither hemodynamic changes nor transient S-T segment changes on the ECG occurred during the operation. In most patients, recovery was rapid and uneventful. No hospital death or morbidity was observed. No blood transfusion was required perioperatively. There were no perioperative neurological cognitive dysfunction events. Maximal pain levels were registered on postoperative day 2 or 3, and pain had abated in most patients on day 5. At follow-up, all patients were in New York Heart Association class I. Conclusions Despite more demanding surgical technique than with full-sternotomy OPCAB, our experience demonstrates that the LOMS for MIDCAB is a technically feasible procedure for myocardial revascularization. Not only the LAD and its branches but also the RCA and can be used safely with very good procedural outcomes.","PeriodicalId":362247,"journal":{"name":"American Journal of Cardiovascular and Thoracic Surgery","volume":"11 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123642689","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Persistent Atrial Fibrillation Ablation Using Circular Irrigated Ablation Catheter","authors":"Nora Al-Jefairi, Ruairidh Martin, J. Sellal, X. Pillois, A. Denis, N. Derval, F. Sacher, M. Hocini, M. Haïssaguerre, P. Jaïs","doi":"10.15226/2573-864x/5/1/00167","DOIUrl":"https://doi.org/10.15226/2573-864x/5/1/00167","url":null,"abstract":"Introduction: Persistent atrial fibrillation (PsAF) ablation remains time consuming, even when guided by non-invasive mapping. We investigated the role of a multielectrode irrigated circular radiofrequency (RF) catheter for PsAF ablation. Methods: A circular catheter (nMARQ®, Biosense Webster, Inc) with 10 irrigated simultaneous mapping and ablation electrodes was used in 50 patients with PsAF (age 60 ± 11 years, left atrial (LA) size 21.8 ± 9.7 cm2 and atrial fibrillation (AF) maximum duration 10.6 ± 9.3 months). Ablation was guided by non-invasive mapping (ECUVETM, Cardioinsight Inc.) in 32 (64%) patients. Pulmonary vein isolation (PVI) was systematically performed. Results: After targeting additional non-PV regions including 3 ± 2 indicated by ECVUETM (1-6), AF terminated in 37 (74%) patients, into atrial tachycardia (AT) in 22 and directly into sinus rhythm (SR) in 15 patients. Thirteen patients were in SR during the procedure. PVI required 8.01 ± 5.27 minutes of RF. Eleven patients required direct current (DC) shock to terminate AF. Linear lesions were performed for AT: 14 LA roof lines, 13 mitral isthmus lines and 27 cavo tricuspid isthmus (CTI). Using total of 20.24 ± 17.25 minutes of RF. Interestingly, 5/8 roof line block, 4/5 mitral isthmus line block and 19/24 CTI line block, were blocked with circular catheter only with 5.08 ± 4.58, 3.30 ± 2.56 and 3.26 ± 2.12 minutes of RF duration, respectively. A single tip conventional ablation catheter was required to complete linear lesions and obtain the block in 3 roof lines, 1 mitral isthmus line and 5 CTI. Mean procedure duration was 3.18 ± 1.03 hours. Complications included 1 pericardia effusion managed conservatively and 1 transient ischemic attack (TIA) resolved without any neurological sequelae. One year follow up data was available in 27 (54%) patients, 18 (67%) patients were in SR and 9 (33%) patients had AF recurrence in whom 1 (3%) patient had AT recurrence. Conclusion: Circular radiofrequency ablation catheter demonstrated encouraging results for rapid, safe and effective PsAF ablation when guided by non-invasive phase mapping. The catheter can be used for linear ablations and CTI in addition to PVI, thus obviating the need for an additional ablation catheter in the majority of patients.","PeriodicalId":362247,"journal":{"name":"American Journal of Cardiovascular and Thoracic Surgery","volume":"25 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129146010","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gasparyan Method of Total Autologous Reconstruction of the Mitral Valve: Case Report","authors":"Feridoun Imam Ali Sabzi, Vahe Ch Gasparyan","doi":"10.15226/2573-864x/5/2/00166","DOIUrl":"https://doi.org/10.15226/2573-864x/5/2/00166","url":null,"abstract":"In this case report we present our first clinical experience of total autologous reconstruction of the mitral valve using the technique, described in the experimental study of Dr. Gasparyan. This is a stentless, autologous valve - a very good alternative for the prosthetic valves in those cases when the mitral valve repair is not possible and its replacement is not desirable. This technique of the mitral valve reconstruction is reproducible and 3 months follow up results are encouraging. Key Words: mitral; valve; reconstruction; mitral reconstruction; autologous pericardium","PeriodicalId":362247,"journal":{"name":"American Journal of Cardiovascular and Thoracic Surgery","volume":"12 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133347943","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Video-Assisted Thoracoscopic Surgery Versus Limited Posterolateral Thoracotomy for Management of Post Traumatic Clotted Hemothorax","authors":"M. Rezk, A. Elnahas, Mamdouh EMohamed, Mona M Elrebigi, Anhar EAbd El-Moteleb","doi":"10.15226/2573-864x/5/1/00164","DOIUrl":"https://doi.org/10.15226/2573-864x/5/1/00164","url":null,"abstract":"Background: Hemothorax is collection of blood in pleural cavity caused by blunt or sharp trauma.Retained hemothorax is an undrained collection in pleura that can lead to fibro-thorax or empyema. Chest tube placement is described as a method of management. Now, videoassisted thoracoscopic surgery (VATS) has evolved to become a gold standard in the management of retained hemothorax. Our objective is to compare VATS with limited thoracotomy in treatment of traumatic retained hemothorax. Patients and Methods: A prospective comparative study conducted on 60 patients with traumatic clotted hemothorax studied between January 2016 and December 2019. Patients were selected and classified into two groups each included 30 patients, Group I managed by open thoracotomy and group II managed by VATS. Results: Our study revealed no difference between both groups regarding age, gender, side of affection or preoperative ICT period. There were a significant reduction in operative time (55.67 Vs 101.3; P = 0.001), post-operative pain (P = 0.001) and postoperative period of ICT insertion (1.2 vs 1.2 day, P = 0.021) and postoperative total hospital stay (3.03 vs. 5.53 day; P = 0.001) and the period needed for return to normal activity (1.03 vs. 2.2 days; P = 0.01) in VATS group versus open thoracotomy group. Conclusion: We concluded that thoracoscopy is feasible, safe and tolerable method for management of retained traumatic hemothorax and so, we recommended it as a suitable method for this type of hemothorax. Key words: VATS; retained hemothorax; limited thoracotomy","PeriodicalId":362247,"journal":{"name":"American Journal of Cardiovascular and Thoracic Surgery","volume":"46 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130828253","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative Study of Virtual Versus Conventional Bronchoscopies as Assistive Diagnostic Tools for the Thoracic Surgeons","authors":"Moataz ERezk, Mamdouh EMohamed, Ashraf MElnahas, A. Shalaan, M. Hamed, M. E. Elnaggar, Amany M Elrubeigy, Mohamed AElgazar","doi":"10.15226/2573-864x/5/1/00165","DOIUrl":"https://doi.org/10.15226/2573-864x/5/1/00165","url":null,"abstract":"Objective: We aim of this work to evaluate the diagnostic accuracy of virtual bronchoscope(VB) compared to conventional bronchoscopies (CB) (fiberoptic (FOB) or rigid (RB)) and the viability of their use by thoracic surgeons. Background: Virtual Bronchoscopy is a recent method that permits visualization and evaluationdown to the fourth order branches. In comparison with CB, VB can analyze extra luminal compressions and also evaluate areas beyond even high-grade stenosis, even more mapping the route for scoping by FOB or RB which may be troublesome or distressing to the patient. Methods: This randomized study included five hundred patients with different lesions of thethorax. All of them were admitted to Benha university hospitals from October 2012 to October 2019. All cases were examined with either FOB or RB then reviewed by radiologists and thoracic surgeons. These results were compared with each other’s. Results: FOB and RB time has been decreased by VB which guide the thoracic surgeon evenmore facilitate transbronchial needle sampling for the extraluminal pathology. Conclusion: VB is currently used in clinical practice and seems valuable to review its potentialclinical diagnostic indications. Both VB and CB might be considered as complementary modalities for confirmation of this diagnosis. Keywords: CT=computed tomography, FOB=fiber-optic bronchoscopy, CB=conventionalbronchoscopy, RB=rigid bronchoscopy, VB=virtual bronchoscopy.","PeriodicalId":362247,"journal":{"name":"American Journal of Cardiovascular and Thoracic Surgery","volume":"153 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130020521","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Interval Surgery for Unstable Traumatic Ventricular Septal Defect","authors":"M. Anwer, S. Mahmood, K. Brown, M. Mori, Ayyaz A. Ali","doi":"10.15226/2573-864x/5/1/00162","DOIUrl":"https://doi.org/10.15226/2573-864x/5/1/00162","url":null,"abstract":"Blunt or penetrating thoracic wall trauma can lead to formation of a traumatic ventricular septal defect. This is a serious cardiac complication that can have dire hemodynamic consequences in a setting of ongoing hemorrhage. This demands urgent surgical repair to cease further deterioration. We describe a patient with traumatic VSD who underwent successful interval repair after management of acute abdomen and stabilization of hemodynamics using vasopressors and Intra-Aortic Balloon Pump (IABP). Keywords: Traumatic VSD; patch repair; left ventricle","PeriodicalId":362247,"journal":{"name":"American Journal of Cardiovascular and Thoracic Surgery","volume":"29 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132890834","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessment of Isolated Blunt Chest Trauma Patients in Benha University Hospital According to Thoracic Trauma Severity Score","authors":"Moataz E Rezk, Ashraf M El Nahas, M. Mohamed, Dina A Saad","doi":"10.15226/2573-864x/5/1/00163","DOIUrl":"https://doi.org/10.15226/2573-864x/5/1/00163","url":null,"abstract":"Background: Chest trauma, in the younger population, is considered a significant cause of morbidity and mortality. A scoring system that can give us a prediction of the thorax related complications in thoracic trauma patients is especially needed. So, the Thoracic Trauma Severity Score (TTSS) was described. The aim of this work: To assess the validity of the Thoracic Trauma Severity Score and its efficacy to predict outcome in blunt thoracic trauma patients. Methodology: Our study included 160 patients of isolated blunt chest trauma attending to emergency room at Benha University Hospital. Results: TTSS when larger than or equal 8 is a good test for prediction of outcome as sensitivity of it reaches 92.3% while specificity is 100% with 97.5% accuracy. Conclusion: This study shows how the usefulness of the TTSS for predicting outcome in thoracic trauma patients, as poor outcome was associated with higher scores. Keywords: Thorax trauma severity score; Blunt thoracic trauma; Trauma outcome","PeriodicalId":362247,"journal":{"name":"American Journal of Cardiovascular and Thoracic Surgery","volume":"216 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"117180834","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Aortic Valve Ejection Fraction for Monitoring Heart Contractility in Patients Supported with a Continuous Flow Left Ventricular Assist Device","authors":"M. Simaan, Viswajith S. Vasudevan, T. Maul, P. Wearden","doi":"10.15226/2573-864x/4/2/00161","DOIUrl":"https://doi.org/10.15226/2573-864x/4/2/00161","url":null,"abstract":"Ejection Fraction (EF) is an important parameter that is used in the diagnosis of heart failure. It provides a measure of the ability of the heart to pump blood into the circulatory system. For patients implanted with a continuous flow left ventricular assist device (LVAD), the standard definition of EF provides a measure of the combined ability of both the heart to pump blood through the aortic valve and the LVAD to pump blood continuously out of the left ventricle both into the circulatory system. In this paper, we introduce a new concept of EF, labeled Aortic Valve Ejection Fraction (or AVEF) which provides an accurate measure of only the ability of the heart to pump blood through the aortic valve while the LVAD is actively running. We investigate the benefits of AVEF and its relation to the LVAD speed using a well-established mathematical model of an LVAD-assisted left ventricle. We compare the sensitivities of the new AVEF index and the standard EF index to changes in heart contractility over a wide range of after loads. Our results show that AVEF is more sensitive to changes in heart contractility than EF. At a typical LVAD speed of 4,000RPM, a 10% improvement in heart contractility over time for a patient with congestive heart failure yields 13.20% increase in AVEF, while the same increase in contractility yields only 7.52% increase in EF. The AVEF index could provide a reliable, non-invasive mechanism for monitoring improvements in heart contractility for patients implanted with LVAD.","PeriodicalId":362247,"journal":{"name":"American Journal of Cardiovascular and Thoracic Surgery","volume":"147 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132339541","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Scimitar Syndrome: Infra-Diaphragmatic Form a Novel Surgical Approach","authors":"C. Riera-Kinkel, Sesbania Bocanegra-Flores, M. Rosas-Peralta, Gabriela B Sanchez, David Roldan-Morales, Jaime Salgado-Vázquez, A. Ramirez-Castañeda, Sebastián Izunza-Saldaña, D. López-Gallegos, H. Márquez-González, Moisés Jiménez-Santos, Lucelli Yañez-Gutierrez","doi":"10.15226/2573-864x/4/2/00160","DOIUrl":"https://doi.org/10.15226/2573-864x/4/2/00160","url":null,"abstract":"Scimitar syndrome is a complex malformation in which the main feature is a partial anomalous venous drainage of the right side toward the inferior vena cava or the portal system. There are anomalies associated in bronchopulmonary segmentation and vascular lung connections [1]. In 1836 in specimens of autopsy Cooper in London published the first description and later Chassinat in París [2, 3]. In 1949 Dotter et, al through angiocardiography shown the first clinical diagnosis where noted the particular appearance of the anomalous vein on x-ray of thorax [4]. Later Neill et, al in 1960 called the scimitar sign for describing this anomaly [5]. Drake and Lynch in 1950 performed the first surgical management of this disease [6]. Later the first physiological correction of anomalous venous drainage was published in 1956 by Kirklin et, al [7]. Finally Neill CA, et al. published the familial occurrence of Scimitar syndrome.","PeriodicalId":362247,"journal":{"name":"American Journal of Cardiovascular and Thoracic Surgery","volume":"19 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129819543","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}