bluuebunny/crossref_metadata_2025 huggingface dataset:
Fluvastatin Induces Apoptosis of Vascular Endothelial Cells: Blockade by Glucocorticoids
Authors: Newton C. J. , Xie Y.-X. , Burgoyne C. H. , Adams I. , Atkin S. L. , Abidia A. , McCollum P. T.
Published: September 2022

Statins block de novo synthesis of cholesterol by inhibiting the enzyme, HMG CoA reductase. The product of this reaction, mevalonic acid, is also a precursor of isoprenoids, molecules required for the activation of signaling G-proteins, such as Ras. Signal transduction pathways involving Ras are important for cell survival and this may be why statins induce apoptotic death of several cell types. Given that statins are used to treat vascular disease, surprisingly no studies have been conducted on vascular endothelial cells. Here we show that fluvastatin (FS), at concentrations from 1–2 μM, blocks growth and induces apoptosis of the endothelial cell line, EA.hy 926. Considerable redundancy is known to exist in cell signaling and In vivo toxicity of FS might be prevented by other signaling pathways, like those activated by adrenal or sex steroids. RT-PCR analysis revealed the expression of the androgen and glucocorticoid receptor in EA.hy 926 cells. Although the androgen, dihydrotestesterone (DHT) had no effect, the glucocorticoid, dexamethasone (Dex), blocked FS-induced apoptosis. Cell cycle analysis revealed that 24 h exposure to FS prevented cells from leaving G 1 and 24–48 h later a marked sub-G 1 peak was observed. Dex was able to reduce the sub-G 1 peak, but it failed to block accumulation of cells in G 1, indicating that it's effect was specific for blockade of apoptosis, and not specific to an effect on FS alone. This study strongly suggests that glucocorticoids have a role to play in preventing vascular injury and they may provide the reason why statins are not inherently toxic to vascular endothelial cells. In vivo.
Preliminary Evaluation of the Sternum Screw: A Novel Method for Improved Sternal Closure to Prevent Dehiscence
Authors: Jutley Rajwinder S. , Shepherd Duncan E. T. , Hukins David W. L. , Jeffrey Robert R.
Published: September 2022

Sternal dehiscence is a relatively rare but serious complication of sternal closure with an unacceptable mortality and morbidity rate. The 6 mm cannulated Sternum Screws are a novel approach that aims to prevent dehiscence. The screws are placed on either side of the sternotomy and wire threaded through the cannula and closed customarily. The Sternum Screws make the bone non-penetrable at the same time retaining the familiarity of conventional stainless steel wire. This novel technique was tested in sheep sterna to compare its efficacy to conventional wire closure. Using tensile testing in a testing machine, randomised controlled closures of the Sternum Screws and No. 5 stainless steel wires were evaluated until system failure. Seventeen matched pairs were tested. The Sternum Screw closure was on average 36% stronger, 284±43 N (mean±SD) compared to conventional wire closure alone. 215±38 N (mean±SD) [ p<0.0001 by t-test]. System failure in 82% of Sternum Screw closures, however, was due to wire breakage or untwisting rather than the screw itself. In all these cases the screw remained intact in bone. 71% of conventional wire closures failed by dehiscing through the sterna. The mean forces required for wire dehiscence and wire failure in the Sternum Screws may be achieved in vivo during large coughs. The study shows there is merit in further evaluating the approach as a method-of preventing dehiscence. It also highlights the use of alternative wiring techniques increase the tensile strength of the closure yet retain the familiarity and versatility of conventional wire.
Hemodynamics of Infrapopliteal PTFE Bypasses and Adjunctive Arteriovenous Fistulas
Authors: Kallakuri S. , Ascher E. , Hingorani A. , Jacob T. , Salles-Cunha S.
Published: September 2022

Purpose

Blood flow, pressure and peripheral resistance in patients with established polytetrafluoroethylene (PTFE) grafts and adjunctive arteriovenous fistulas (AVF) have rarely been investigated. To better elucidate the effects of this AVF, we obtained noninvasive measurements of hemodynamic variables in patients with infrapopliteal PTFE grafts and an AVF.

Methods

Systolic, mean and diastolic arm and toe pressures were measured with an oscillometric technique employed in automatic blood pressure monitors. Peak-systolic velocity, end-diastolic velocity and flow rates at the graft and recipient distal artery were measured with duplex ultrasound. Resistance for the leg and foot in peripheral resistance units (PRU) was estimated as mean arm pressure divided by graft flow rate and as mean toe pressure divided by distal artery flow rate respectively. We analyzed data from 21 patients. Toe pressures were measurable in 13 patients. Bypass graft inflow was at the external iliac artery in 11 patients, common femoral in six, common iliac in two and superficial femoral in two. The distal anastomosis was at the anterior tibial artery in 10 patients, peroneal in seven and posterior tibial in four patients.

Results

Graft systolic and diastolic velocities were 91 ± 46 (mean±sd) and 38 ± 31 (mean±sd) cm/s respectively. Toe systolic pressure averaged 81 ± 28 (mean±SD) mmHg with a corresponding toe/brachial index (TBI) of 0.53 ±0.18 (mean±SD). The ratio between arm mean pressure, 104 ± 20 (mean±SD) mmHg, and graft flow rate, 413 ± 290 (mean±sd) ml/min, yielded an estimated leg resistance of 0.32 ± 0.20 peripheral resistance units (PRU) (mean±sd). The ratio between mean toe pressure, 51 ± 21 (mean ± SD) mmHg, and distal artery flow rate, 37 ± 26 (mean±SD) ml/min, produced an estimated foot resistance averaging 1.66 ± 1.18 PRU (mean±sd).

Conclusions

Average graft flow rate was five times greater than flow reported for standard tibial bypasses. Although distal artery flow rate and graft peak systolic velocity were within reported normal ranges, mean toe pressure and toe-brachial index were below normal. Leg and foot resistances were decreased. These data suggest that bypasses with arteriovenous fistulas have increased flow, desirable for graft patency, but may affect distal perfusion pressure.
The Relationship between the Method of Cardioplegia and Vascular Endothelial Cell Derived Soluble Adhesion Molecules in Myocardial Ischemia-Reperfusion Injury
Authors: Enc Yavuz , Serbetcioglu Aykut , Karsli Fuad , Sokullu Onur , Sanioglu Soner , Kurc Pelin , Yapici Fikri , Bilgen Fuat , Şahin (Özgün) Sükran
Published: September 2022

The relative role of different adhesion molecules in the ischemia-reperfusion injury after cardioplegic arrest in the clinical setting is unknown, because of protective effects of cardioplegia and hypothermia. The aim of this study is to determine the relationship between the method of the cardioplegia and endothelial derived soluble adhesion molecules; soluble vascular adhesion molecule-1 (sVCAM-1) and soluble intercellular adhesion molecule-1 (sICAM-1) in myocardial ischemia-reperfusion injury. Fourteen male patients who underwent aortocoronary bypass surgery with cardiopulmonary bypass were included in this study. They were randomised to be given blood or crystalloid cardioplegia for myocardial protection. Group I ( n = 7) received blood cardioplegia and group II ( n = 7) received crystalloid cardioplegia. The cross-clamp times were not significantly different between the two groups, 49.4±4.6 min for group I and 54.8±12.5 min for group II. Mean age of patients was 58±2.1 years for group I and 54±2.6 years for group II. Blood samples were taken from both the aorta and coronary sinuses of all patients before cross-clamp, after cross-clamping and at 30th min of reperfusion. Plasma were obtained from blood samples and then stored at −70°C. sVCAM-1 and sICAM-1 levels were measured by ELISA in the samples. There were no significant differences in the levels of sICAM-1 and sVCAM-1 at the beginning of reperfusion and at 30th min of reperfusion in coronary sinus of group I patients. But, increased sICAM-1 and sVCAM-1 levels were observed at 30th min of reperfusion in blood taken from coronary sinuses of group II patients compared with beginning of reperfusion (respectively p = 0.01, p = 0.03). In conclusion, these results have shown that ischemia-reperfusion injury is more likely to occur in patients protected by crystalloid cardioplegia, and suggest that blood cardioplegia may be preferred especially in borderline myocardial functioned patients.
The Use of Acute Normovolemic Hemodilution in Patients Undergoing Cardiac Surgery
Authors: Jović Miomir -D. , Čalija Branko M. , Radomir Boško J. , Perić Miodrag S. , Krivokapić Borislav N. , Jagodić Siniša P. , Babić Milan J. , Dukanović Boško P.
Published: September 2022

Avoiding allogeneic blood transfusion during cardiac surgery and during the post-operative period is of great importance. Acute normovolemic hemodilution (ANH) is one of the options for blood salvage. We have prospectively analyzed 310 consecutive patients (pts) after different open heart procedures, operated on during April—May, 2000. ANH was possible in 226 pts (73%) with hemoglobin level over 125 g/l and hematocrit over 36%. Of those, one unit of blood was withdrawn in 128 pts (70%), while two to five units of blood were taken in 68 pts (30%). Total number of autologous blood units taken was 296, for the average of 1.31 units/pt. Predictors of increased intra- and post-operative blood loss were hematocrit (Hct) <39% (76% vs. 24%, p<0.001), age over 65 ( p=0.028), female sex ( p=0.006), CPB duration over 90 min (63% vs. 37%; p<0.001) and preoperative left ventricular ejection fraction (LVEF) <35% (63% vs. 37%; p<0.001). All pts with the above-mentioned characteristics were in need for allogeneic blood transfusion. During their hospital stay, 142 pts did not get allogeneic blood (142/310, 46%), and all were in the ANH group (142/226, 62%).
Risk Factors Influencing the Outcome after Surgical Treatment of Complicated Deep Sternal Wound Complications
Authors: Peivandi A. A. , Kasper-König W. , Quinkenstein E. , Loos A. H. , Dahm M.
Published: September 2022

Background:

Median sternotomy is the most frequently used incision for cardiac procedures but carries a substantial risk for deep sternal wound infections and/or sternal dehiscence. In contrast to previous studies that examined risk factors for sternal infections this study evaluates factors that lead to poor outcome after surgical revision of the non healing sternum.

Methods:

Between 1985 and 1999, 193 adults (mean age 64 ± 9 years, m/f = 3/1) necessitated sternal revisions (incidence 1.93%). Pre-, intra- and post-operative risk factors were evaluated for their influence on the outcome after sternal revision.

Results:

65 of the 193 patients had a complicated course: ten (5.2%) died due to sepsis/multi organ failure ( n = 6) or cardiac causes ( n = 4). 32 patients (16.6%) needed several revisions, 17 (9%) were discharged with sternal instability, 5 (3%) with chronic fistula and one with persistent osteomyelitis. Univariate and multivariate analysis identified cardiopulmonary resuscitation (odds ratio ( OR) = 11.188, p = 0.010), corticoid treatment ( OR = 7.043, p = 0.0055), diabetes ( OR = 4.130, p = 0.0128), smoking history ( OR = 2.996, p = 0.0041), renal insufficiency (hazard ratio ( HR) = 1.884), old age ( OR = 1.108, p = 0.0266), high body mass ( HR = 1.06), ECC time ( p = 0.023), cross clamp time ( p = 0.028), systemic hypothermia ( p = 0.016), non-use of IMA ( p = 0.042) or prolonged ventilation as risk factors for mortality or poor outcome. No correlation between sternal closure technique, mediastinal irrigation or antibiotic therapy and outcome after mediastinal revision could be found.

Conclusions:

To avoid disappointing results after sternal revision one should aim to preoperatively identify high-risk patients and aggressively address risk factors. This rather than modifications of the surgical and medical approach might improve the outcome of patients with mediastinal complications.
Can ε-Aminocaproic Acid Balance the Off-Pump Bleeding Advantage?
Authors: Stassano P. , Musumeci A. , Santise G. , Gagliardi C. , Montalto A. , Spampinato N.
Published: September 2022

Background:

Aprotinin improved the control of bleeding in patients undergoing surgery with cardiopulmunary bypass, but its use was halted because of the risk of bovine spongiform encephalopathy. We then started to use ε-aminocaproic acid and the results in the control of bleeding were satisfactory. To assess its effectiveness in the control of postoperative bleeding precisely, we compared the results for patients operated on for myocardial revascularization on-pump and treated with ε-aminocaproic acid with those for patients who decidedly bleed less: off-pump patients.

Methods:

Two groups of patients who had had either on- or off-pump double aortocoronary bypass surgery were retrospectively reviewed for postoperative bleeding. These two almost homogeneous group had two grafts only: left anterior descending and circumflex arteries operated on with cardiopulmonary bypass and treated with the ε-aminocaproic acid, and left anterior descending and right coronary arteries operated on off-pump.

Results:

Postoperative bleeding through chest drainage at 4 h was 265 ± 91.7 mL in the off-pump group and 328.4 ± 131.4 mL in the on-pump group ( p = 0.004). But at 24 h it was 671.6 ± 311.5 mL in the off-pump group and 827.8 ± 514.4 mL in the on-pump group ( p = 0.07).

Conclusions:

ε-Aminocaproic acid is effective in controlling postoperative bleeding in patients operated on for myocardial revascularization with the aid of cardiopulmonary bypass.
Pericardial Collar Modification for Ross Procedure
Authors: Sarioglu T. , Erek E. , Yalçinbas Y. K. , Salihoğlu E. , Sarioglu A. , Tekin S.
Published: September 2022

Although the surgical technique of the Ross operation has been improved over the years, there are still some technical difficulties: (1) The possibility of damage to first septal artery during harvesting and reconstruction of right ventricular outflow tract (RVOT). (2) Weak posterior anastomotic area during RVOT reconstruction. (3) Persistent bleeding from septal dissection site of pulmonary autograft. To deal with these difficulties, we used a 1-cm wide pericardial strip (pericardial collar) which was sutured to epicardium at the posterior and septal edge of the RVOT. The conduit used for the reconstruction of pulmonary outflow was then sutured to this pericardial strip at the posterior part of the anastomosis. We found this technique very useful to create a safe and strong margin for the posterior suture line. Persistent bleeding from septal dissection site can be also avoided using this modification by diverting the bleeding site into the right ventricular cavity.
Tuberculous Abdominal Aortic Pseudoaneurysm Penetrating the Left Psoas Muscle after BCG Therapy for Bladder Cancer
Authors: Wada S. , Watanabe Y. , Shiono N. , Masuhara H. , Hamada S. , Ozawa T. , Fujii T. , Yokomuro H. , Kawasaki M. , Yoshihara K. , Koyama N.
Published: September 2022

We describe a case of a 75-year-old man with abdominal aortic and right femoral tuberculous pseudoaneurysms 32 months after intravesical bacillus Calmette-Guerin therapy for bladder cancer. These aneurysms were probably brought on by systemic infection by Mycobacterium bovis. The infrarenal aorta and right common femoral artery were successfully replaced with an in situ expanded polytetrafluoroethylene graft.

Tuberculous pseudoaneurysm after bacillus Calmette-Guerin therapy for malignancy is very rare, and we review the related literature.
Infected Myocardial Hydatid Cyst Imitating Left Ventricular Aneurysm
Authors: Kutay V. , Ekim H. , Yakut C.
Published: September 2022

We report a case of infected intracardiac hydatid cyst in a patient who had complaints of chest pain, exertional dyspnea, palpitation, evening fever and fatigue. Echocardiography demonstrated a left ventricular apical cystic mass in 7 cm diameter. Magnetic resonance imaging and hemagglutination test confirmed the diagnosis. Single capsulated cyst full of pus was surgically removed by using cardio-pulmonary bypass. Histopathological examination revealed an infected hydatid cyst. Postoperative recovery was uneventful and the patient remains free of symptoms after one year of follow-up.
Aortic Pseudoaneurysm Complicating Sternal Wound Infection following CABG
Authors: Devbhandari Mohan P. , Balasubramanian Sendhil K. , Campanella Ciro , Brackenbury Edward T.
Published: September 2022

Pseudoaneurysm of the ascending aorta following coronary artery bypass grafting is a rare complication. In this report we present two such cases. We were successful in repairing the false aneurysm and sternal dehiscence in one case. The clinical features, diagnosis and surgical management are discussed.
Left Atrial Thrombosis after Heart Transplantation
Authors: Castedo E. , Burgos R. , Cañtas A. , Cabo R. A. , Serrano-Fiz S. , Segovia J. , Ugarte J.
Published: September 2022

Left atrial thrombosis in the absence of rheumatic heart disease and atrial fibrillation is a rare occurrence. We report two cases of left atrial pedunculated thrombus formation after orthotopic heart transplantation. Despite an uneventful post-operative course, sinus rhythm and normal contractility of the heart, large thrombi could be found several months following transplantation. Surgical thrombectomy was performed under cardiopulmonary bypass. Operative technique is proposed as one of the main factors that can contribute to left atrial thrombosis after heart transplantation.
Long-Term Effectiveness of Operative Procedures for Stanford Type A Aortic Dissections
Authors: Driever R. , Botsios S. , Schmitz E. , Donovan J. , Vetter H. O.
Published: September 2022

Background:

To evaluate long-term effectiveness of strategies for managing the aortic root and distal aorta in type A dissections.

Methods:

From 1990 to 1999, 50 patients (32 men, 64.07%; 18 women, 36.0%; mean age 57.4 y ± 11.1) underwent operation for ascending aortic dissection. Surgical strategies included aortic root replacement with a composite graft (21/50; 42.0%), valve replacement with supracoronary ascending aortic graft (3/50, 6%), and valve preservation or repair (26/50; 52.0%).

Results:

Overall hospital mortality rate was 18.0%. Follow-up was completed for 47 patients (94.0%) and ranged from 1 month to 10.5 years (mean 28.8 months). Actuarial survival for patients discharged from the hospital was 84% at 1 year, 75% at 5 years, and 66% at 10 years. There was no significant difference between the various procedures regarding mortality, neurological complications, long term survival and proximal re-operations. The ascending aorta alone was replaced in 8/50 patients (16%), ascending and hemiarch in 30/50 patients (60%) and arch and proximal descending aorta in 12/50 patients (24%) Hospital mortality (11.5, 20.0 and 16.7% respectively; p > 0.05) and 5- and 10-year survival ( p > 0.05) were not statistically dependent on the extension of the resection distally. Residual distal dissection was not associated with a decrease in late survival. With regard to emergency surgery (36/50) there was no significant difference in hospital mortality ( p > 0.05) and 5 year survival ( p > 0.05) between those who had undergone coronary angiography (19/36; 52.8%) on the day of surgery with those who had not (17/36; 47.2%).

Conclusions:

Preservation or repair of the aortic valve can be recommended in the majority of patients with type A dissection. Distal extension of the resection does not increase surgical risk. Residual distal dissection does not decrease late survival. Preoperative coronary angiography may not affect survival in patients undergoing emergency surgery.
Operative Risk Factors of Type A Aortic Dissection: Analysis of 252 Consecutive Patients
Authors: Tan M. Erwin S. H. , Dossche Karl M. E. , Morshuis Wim J. , Knaepen Paul J. , Defauw Jo J. A. M. , van Swieten Henry A. , van Boven Wim-Jan , Kelder Johannes C. , Waanders Frans G. J. , Schepens Marc A. A. M.
Published: September 2022

Objective:

We examined operative risk factors for postoperative death after surgery for acute type A aortic dissection.

Methods:

Between 1974 and 1999, 252 patients, 163 men and 89 women (mean ± SD age, 58 ± 12 years) underwent surgery for acute type A aortic dissection. Fifty-eight (23.0%) were in cardiogenic shock at time of surgery. Most patients underwent ascending aorta replacement which was combined with aortic valve replacement by means of a composite graft in 30 (11.9%) patients and an isolated aortic valve replacement in 16 (6.3%) patients.

Results:

The overall operative mortality rate was 25.0% ( n = 63); 27.0% for patients operated upon with aortic cross-clamping, 23.7% after deep hypotherm circulatory arrest and 23.3% after antegrade selective cerebral perfusion (ASCP) ( p = 0.73). Multivariate analysis revealed iatrogenic dissection ( p = 0.0096, odds ratio = 5.7), preoperative cardiopulmonary resuscitation ( p = 0.0095, odds ratio = 5.5) and every quarter of an hour longer extracorporeal circulation ( p = 0.049, odds ratio = 1.1) as independant risk factors for operative mortality. Aortic valve replacement or Bentall procedure ( p = 0.0185, odds ratio = 0.3) were protective factors. There were 44 new postoperative strokes: 4.7% in the group operated upon with and 20.1% in the group without ASCP ( p = 0.01).

Conclusion:

In order to avoid cardiogenic shock and preoperative cardiopulmonary resuscitation, patients with acute type A aortic dissection should be treated promptly. The choice to use an aortic valve prosthesis or Bentall procedure when applicable seems to benefit the postoperative early survival. The risk of new postoperative neurological events might be reduced by avoiding the appliance of an aortic cross-clamp and by using ASCP.
Endoluminal Aortic Shunting for Distal Perfusion during Thoracic Aortal Cross-Clamping in a Pig Model
Authors: Ditmarsch M. , Yilmaz E. N. , Vahl A. C. , van Genderingen H. R. , van Rij G. L. , Rauwerda J. A.
Published: September 2022

Purpose of the study:

To investigate the haemodynamic properties of a direct endovascular aortic shunt to maintain distal aortic perfusion as an alternative of a distal shunt (left-left-,Gott shunt) in thoracic aortic aneurysm repair.

Methods:

A shunt was developed and tested in an in vitro model which should be capable of transporting a flow of 3–4 L/min with a decrease in blood pressure < 20 mmHg. Thereupon the shunt was tested in an in vivo experiment in six pigs to assess the possibility of its use with normal distal blood pressure. The shunt was inserted in the thoracic aorta and stayed in place for 1.5 h. Parameters were measured at six time intervals to assess organ perfusion, -function, cardiac output, proximal- and distal blood pressure and aortic- and shunt flow.

Principle findings:

The mean blood flow through the shunt was 2.5 L/min. The difference of the mean blood pressure over the shunt was on average 14.20 mmHg. Parameters for coagulation disturbance and organ ischaemia were tested. The decrease in mean trombocyt count was 299–158 ( p < 0.02). The venous lactate and the venous mesenteric lactate as parameters for intestinal ischemia did not increase significantly. No significant changes occurred in angiotensin II levels. Pulsatile flow was maintained but significantly suppressed (60%) distal from the shunt. The clamp time needed to insert the shunt and the venous mesenteric lactate, as well as the venous lactate, showed high correlation, r s = 0.9 ( p < 0.05) and r s = 0.94 ( p < 0.01). This also accounted for the 2nd clamp time, both r s = 0.95 ( p < 0.05).

Conclusion:

The shunt is capable of transporting a blood flow of 2–4 L/min with an acceptable decrease in distal blood pressure. However, the time, needed to insert the shunt, was significantly associated with parameters of organ ischaemia.
Integrated Approach to Off-Pump Coronary Artery Bypass Surgery
Authors: Al-Ruzzeh S. , Amrani M. , Boscoe M. , Farrimond J. , Riedel B. , Wright I. , George S.
Published: September 2022

Background:

The Off-Pump Coronary Artery Bypass (OPCAB) technique is becoming more popular in many cardiac units throughout the world. This relatively new technique has prompted surgeons and anaesthetists to review and modify the routine approach to Coronary Artery Bypass Surgery (CABG). In this study we reviewed and analysed the outcome of an integrated anaesthetic and surgical peri-operative approach that allowed routine use of OPCAB and avoided the use of cardiopulmonary bypass (CPB).

Methods:

We reviewed and analysed the data on the first consecutive 285 patients who were operated on using the OPCAB technique. These represent our initial experience with applying the OPCAB technique non-selectively for all patients over a period of 16 months.

Results:

All patients had at least 2-vessel disease. 807 grafts were performed (mean 2.8 per patient) of which 647 (80%) were arterial (mean 2.3 per patient). 179 (63%) patients underwent total arterial revascularization. Eight patients required cardiopulmonary bypass; all other operations were completed off-pump. Complications — mortality 3 (1%); renal failure 24 (8%); stroke 3 (1%) and atrial fibrillation 60 (21%).

Conclusion:

This retrospective analysis shows that provided a combined and integrated anaesthestic and surgical approach is used, beating heart technique for CABG can be safely offered to all patients with a good outcome.
The Frequency of Pleural Effusions after Bellovac Drainage following Coronary Bypass Grafting
Authors: Dunning Joel , Megahed Mahmood , Millner Russell W. J.
Published: September 2022

Background:

A common postoperative complication after CABG with internal mammary artery (IMA) harvest is the evolution of a pleural effusion. Our aim was to see if the intra-operative insertion of a Bellovac drain to the pleural cavity, with drainage continuing for 4-days post operation, eliminates the complication of pleural effusion.

Methods:

Using our computerised audit database, 500 consecutive patients were identified who had undergone CABG including at least one internal mammary graft by a single consultant at Blackpool Victoria Hospital. All these patients received Bellovac drainage for 4 days on the side of the harvested IMA. The chest X-ray reports were retrospectively collected from the hospital computer databases. The 4-day post-operative, and the 6-week post-operative films were found. In the cases where no consultant radiologist report was found J.D. reviewed the film, and any abnormalities were also reviewed by R.W.J.M.

Results:

Out of 500 radiographs, six patients (1.2%) died, 25 patients had no traceable record of a chest X-ray, 434 patients had an entirely normal chest X-ray and 461 patients had no effusion at 6 weeks. Six patients had a small effusion at 6 weeks, two had a moderate effusion successfully treated conservatively, and no patients had a pleural effusion that required drainage.

Conclusion:

In patients undergoing coronary arterial bypass grafting with Internal mammary artery harvest, the intra-operative insertion of a Bellovac drain on the side of the harvested IMA reduces the risk of postoperative pleural effusions
Should Ruptured Abdominal Aortic Aneurysms be Repaired in the Octogenarian?
Authors: Roddy Sean P. , Darling R. Clement , Maharaj Dale , Ozsvath Kathleen J. , Mehta Manish , Paty Philip S. K. , Kreienberg Paul B. , Choi Daniel , Chang Benjamin B. , Shah Dhiraj M.
Published: September 2022

Purpose.

Several investigators have suggested a dismal prognosis of ruptured abdominal aortic aneurysm (rAAA) repair in the elderly. The purpose of this study is to evaluate the morbidity and mortality of rAAA repair in octogenarians and compare it to that of a younger population.

Methods

From 1980 to 2000, all patients undergoing emergent rAAA repair were divided into two groups based on their age; Group I: age <80, Group II: ?⩾80 years. Outcomes were evaluated based on a Chi-square test and a P-value <0.05 indicated statistical significance.

Results

Over a 20-year period, 323 patients underwent rAAA repair through a left retroperitoneal (74%) or standard transperitoneal (26%) approach. In Group I (age <80 years) and II (⩾80 years), the overall 30-day mortality was 25 and 41% ( P < 0.05), respectively. Furthermore, the elderly population had a higher incidence of death due to myocardial infarction (15 vs. 7%), as well as non-fatal cardiac and cerebrovascular events (17 vs. 4%) when compared to the younger patients.

Conclusion

Although the elderly patients have an increased risk of having cardiac and cerebrovascular events in the postoperative period, the treatment of rAAAs in these patients should not be any different than that of a younger population. The left retroperitoneal approach is feasible and beneficial for rAAA repair and is associated with a limited morbidity and mortality.
Neuroprotective Effect of N-Acetylcysteine and Hypothermia on the Spinal Cord Ischemia—Reperfusion Injury
Authors: Cakir Omer , Erdem Kemalettin , Oruc Ahmet , Kilinc Nihal , Eren Nesimi
Published: September 2022

The purpose of this study was to investigate the effect of N-acetylcysteine (NAC) on spinal cord ischemia-reperfusion (I—R) in rabbits. Thirty rabbits were divided into five equal groups, group I (sham-operated, no I—R). group II (control, only I—R), group III (I—R + NAC), group IV (I—R + hypothermia), group V (I—R + NAC + hypothermia). Spinal cord ischemia was induced by clamping the aorta both below the left renal artery and above the aortic bifurcation. Forty-eight hours postoperatively, the motor function of the lower limbs was evaluated in each animal according to Tarlov Score. Spinal cord samples were taken to evaluate the histopathological changes. The sham-operated rabbits (group I) showed no neurologic deficit (Score = 4). Paraplegia (Score = 0) developed in all rabbits in the control group (group II). Administration of 50 mg/kg of NAC (group III) resulted in significant reduction of motor dysfunction (Score = 3.1 ± 1.3. p = 0.002). Application of hypothermia alone (group IV) showed significant recovery of motor functions (Score = 3.0 ± 1.1. p = 0.002). and combination of hypothermia and 50 mg/kg of NAC (group V) showed complete recovery of lower limb motor function (Score = 4, p = 0.001). Histologic examination of the spinal cord in rabbits with paraplegia revealed several injured neurons. The cords of animals with no motor function deficits showed only minimal cellular infiltrates in the gray matter, and there was good preservation of nerve cells. NAC showed protective effects of the spinal cord. Moderate hypothermia alone also showed protective effects. Combined use of NAC and hypothermia resulted in highly significant recovery of spinal cord function.
Quality of Life and NYHA Class 30 Years after Mechanical Aortic Valve Replacement
Authors: Maliwa M. A. , van der Heijden G. J. M. G. , Bots M. L. , van Hour B. A. , Casselman F. P. , van Swieten H. , Vermeulen F. E. E.
Published: September 2022

Objective

(1) To evaluate the quality of life (QoL) scores, assessed with SF36 and EuroQol (EQ-5D), of long term survivors after mechanical aortic valve replacement (mAVR); (2) to study the association of QoL with NYHA score, number of major bleeding and thrombo-embolic events and follow-up time; (3) to compare QoL scores of long term mAVR survivors with QoL scores of other populations.

Methods

In total 312 patients had a mAVR between 1964 and 1974 at St. Antonius Hospital Nieuwegein (NL). Mean age at operation was 41 ( sd = 12). Mean postoperative NYHA class at 1-year follow-up was 1.7 ( sd = 0.7). In 2001 the survivors ( n = 78; 25%) were followed-up for late events, NYHA class and QoL scores. 69 patients (93%) returned completed questionnaires.

Results

Mean duration of follow-up was 30 years ( sd = 1.8). Mean age of responders was 65 years ( sd = 10, range 47–93). In 2001, NYHA class of responders was 2 ( sd = 0.9). The mean (sd) SF36 scores for responders were: 64 (29) for physical function. 64 (29) for role-physical, 80 (30) for bodily pain. 55 (25) for general health, 63 (23) for vitality. 73 (29) for social functioning, 70 (38) for role-emotional, 76 (18) for mental health. The mean EQ-5D score of responders was: 61 (13). These SF36 and EQ-5D scores are comparable to those of other populations (e.g. cancer, diabetes type-2, migraine, chronic liver disease and iliac artery occlusive disease and Dutch general population). For responders a moderate to high association of SF36 and EQ-5D scores and their NYHA scores(R2 = 0.36) was found. The number of major bleeding events, age, sex and survival time were not related to QoL.

Conclusion

At long term follow-up (mean 30 years) of patients who had mAVR, QoL was relatively high; it was moderately to highly associated with their NYHA class; bleeding and thromboembolic events seem to be of little importance for the QoL at long term follow-up. QoL at long term follow-up of patients who had mAVR is comparable to other cross sectional designed studies with short term follow-up and other population.
Minimally Invasive Coronary Artery Bypass Grafting in High-Risk Patients. Late Follow-Up with Assessment of Left Internal Mammary Artery Graft Patency and Flow by Exercise Transthoracic Doppler Echocardiography
Authors: Sunderdiek U. , Kalweit G. A. , Marx R. , Schipke J. D. , Gams E.
Published: September 2022

Patients with significant risk factors are at increased risk of higher mortality and morbidity (9–16%) after CABG-procedures with cardiopulmonary bypass (CPB). When catheter interventions are not applicable and conventional CABG with CPB are considered to have an unacceptable perioperative risk, these patients ( n = 35) were scheduled for minimally invasive coronary artery bypass grafting (MIDCAB).

Patients and methods: The risks leading to exclusion of conventional CABG procedures were: extremely impaired LV-function (EF < 20%), severe pulmonary diseases, malignant carcinoma, compromised coagulation system, age >80 years with impaired physical constitution, redoprocedures after complicated initial operation, symptomatic descending thoracic aortic aneurysm, ongoing long-term intensive care treatment with unclear prognosis. All patients received the LIMA as a single graft to the LAD. One year follow-up was performed using transthoracic Doppler echocardiography at rest and during exercise.

Results:

In 20 patients incomplete revascularization was accepted. There was no mortality, while signs for myocardial infarction were seen in two patients. Twenty-nine patients (82%) showed clear improvement of clinical symptoms, one patient needed further conventional CABG. Nine to thirteen months postoperatively (mean 10.8 ± 1.6 months), there were two deaths due to noncardiac reasons. Three of the survivors ( n = 33) had symptoms of angina pectoris. Exercise tests revealed an improved stress tolerance (NYHA class improved from preop. III—IV to postop. I—II). The IMA graft flow increased significantly with exercise in all patients. Flow patterns in both flow velocity and volume changed to diastolic-dominant, and the ratio of diastolic to systolic time-velocity integral of > 1.5 excluded a graft stenosis.

Conclusions:

In high-risk patients, with an increased likelihood of perioperative morbidity and mortality, the MIDCAB procedure can be performed accurately and safely. Even after incomplete revascularization of some high-risk patients, exercise tolerance was improved. Transthoracic Doppler echocardiography proved to be a clinically useful noninvasive method of assessing IMA graft function at rest and during exercise. Despite the small patient population, our late follow-up results suggest the potential benefit of MIDCAB for patients with otherwise inoperable heart disease.
Minimally Invasive Off-Pump Pulmonary Embolectomy
Authors: Ashrafian Hutan , Kumar Pankaj , Athanasiou Thanos , Stanbridge Rex D.
Published: September 2022

We report the case of a 35-year-old female with acute massive right pulmonary embolism, successfully treated by a minimally invasive off-pump pulmonary embolectomy—the first case in the literature implemented via the J-ministernotomy.
Experiences in Robotically Enhanced IMA-Preparation as Initial Step towards Totally Endoscopic Coronary Artery Bypass Grafting
Authors: Reuthebuch O. , Comber M. , Grünenfelder J. , Zünd G. , Turina M.
Published: September 2022

Aim

To evaluate the feasibility of robotically enhanced preparation of internal mammary arteries (IMA).

Method

Via three trocars in left thoracic wall the left, right or both IMA were skeletonized under CO2 insufflation and single lung ventilation using electrocautery.

Results

In 12 months, 26 LIMA, five BIMA and one RIMA were dissected. In five patients, the procedure had to be determined (IMA injury (two), respiratory insufficiency (two), and heart penetration (one)). Mean intrathoracic pressure was 9.7 ± 1.5 mmHg. Mean time for LIMA and RIMA dissection was 66.7 ± 21.1 and 99.2 ± 8.7 min, respectively. In 10 patients, pericardium was incised and course of LAD assessed. However, in two patients, this coronary did not correlate with LAD. Time for instrument change depended on type of tool (cautery blade: 24.9 ± 13.1 s, clip applier 72.8 ± 28.4 s).

Conclusion

Robotic dissection of IMA is reasonable. However, life-threatening complications can barely be managed due to inadequate tools and excessive time for instrument change. Incorrect determination of coronaries can result in misplaced anastomoses.
Classification of Left Main Coronary Obstruction—Feasibility of Surgical Angioplasty and Survival after Coronary Artery Bypass Surgery
Authors: Jönsson A. , Ivert T. , Svane B. , Liska J. , Jakobsson K. , Hammar N.
Published: September 2022

Angiographies of 384 patients who had coronary artery bypass surgery because of left main coronary artery (LMCA) obstruction during 1970–1989 were reviewed by analysing the pathology, feasibility of surgical angioplasty and survival. Complete LMCA occlusion was found in 2%, proximal ostial stenosis in 9%, mid-shaft stenosis in 24%, circular stenosis in 25% and distal bifurcation stenosis in 40% of the patients. Patients with an ostial stenosis were younger, more often women with less coronary artery disease and less calcified obstructions. Surgical angioplasty could have been an option in 22% of the patients. Early mortality was higher in patients with (4.7%) than in those without (1.9%) LMCA obstruction. The relative risk (RR) of early death was 1.9 (95% CL 1.1–3.5) after adjustment for patient characteristics. Similarly, the RR at 10 years was 1.3 (95% CL 1.0–1.6). LMCA obstruction was associated with an early and long-term increased mortality after surgery compared to patients without LMCA obstruction.
Conservative vs. Invasive Treatment of Aortocoronary Saphenous Vein Graft Aneurysms: Treatment Algorithm Based upon a Large Series
Authors: Dieter Robert S. , Patel Ashvin K. , Yandow Donald , Pacanowski John P. , Bhattacharya Abhik , Gimelli Giorgio , Kosolcharoen P. , Russell Douglas
Published: September 2022

Background

The development of a saphenous vein graft aneurysm (SVGA) after coronary artery bypass graft surgery is a rare occurrence. There are approximately 60 cases reported in the literature, the majority being single case reports. There is no consensus on the treatment of SVGA.

Methods

Retrospective analysis of the patients treated with SVGA was performed at our institution. Demographic and co-morbidity data were acquired on the patients. Patients who underwent surgical treatment were compared to those treated conservatively with the primary outcome being survival time from diagnosis of the SVGA.

Results

Thirteen patients with 15 SVGA were identified. The average age at the time of the most recent coronary artery bypass grafting (CABG) was similar in the conservative and the surgically treated groups (55 vs. 56.5 years, respectively). The average number of grafts per patient at the most recent CABG was similar (3.83 vs. 4.0, respectively). The average time from CABG to diagnosis was similar in both the groups (12.6 vs. 15 years, respectively). The average survival from diagnosis was similar in both the groups (2.3 vs. 1.5 years, respectively, p > 0.05).

Conclusions

Early surgical treatment of SVGA does not provide longer short-term survival compared with conservative management. A treatment algorithm for SVGA based upon patient co-morbidities and aneurysm characteristics is proposed.
Coil Embolization of an Inferior Pancreaticoduodenal Artery Aneurysm Associated with Celiac Artery Occlusion
Authors: Peterson Brian G. , Resnick Scott A. , Eskandari Mark K.
Published: September 2022

Pancreaticoduodenal arcade aneurysms are rare. Untreated, these lesions enlarge progressively and have the potential for spontaneous rupture. Aneurysmal degeneration of pancreaticoduodenal arcade vessels is known to be associated with celiac artery occlusion, vasculitis, and certain connective tissue disorders. Given their precarious location, surgical expiration is a challenging endeavor. Innovations in endovascular techniques offer a possible alternative.

We report a case of a 55-year-old gentleman with a 2.2 × 2.1 - cm aneurysm of one of the inferior pancreaticoduodenal arteries and a concomitant finding of occlusion of the celiac artery trunk. Percutaneous coil embolization of the aneurysm was employed as the treatment in this case with the successful exclusion of the aneurysm sac, while maintaining continuity of the native circulation.

This case report demonstrates that, due to the success rate of aneurysm exclusion and the relatively low morbidity and mortality rates seen with endovascular repair as compared to surgical intervention, endovascular treatment has become the treatment of choice for pancreaticoduodenal artery aneurysms.
Intracavitary Cardiac Hydatid Cyst
Authors: Abid A. , Ben Omrane S. , Kaouel K. , Marghli A. , Dhiab M. , Abid N. , Ben Zarkouna S. , Khayati A.
Published: September 2022

The purpose of this study is to determine the diagnosis means, the surgical management and the prognosis of patients with intracavitary cardiac hydatid cyst.

We report a series of seven patients. The diagnosis was orientated by coexisting pulmonary locations in all patients. The cyst was located in the right cardiac chambers. Cardiopulmonary bypass with aortic cross clamping and cardioplegia was necessary in all cases.

The postoperative course was satisfactory for all patients. There was a recurrence of pulmonary cysts in all patients after a mean duration of 42 months. Medical treatment (Albendazole) was instituted. One late death occurred at 3 years of follow-up due to chronic right heart failure.

In conclusion, cardiac hydatid cysts with intracavitary location must be suspected in patients with pulmonary or systemic embolization. Early surgical treatment is necessary and medical treatment must be instituted after surgery.
Straight Segmental versus Bifurcation Grafts for Repair of Abdominal Aortic Aneurysm
Authors: Wilson S. E. , White G. , Williams R. A.
Published: September 2022

The decision of two surgical teams to repair an infrarenal aneurysm with a straight or bifurcation graft in 94 patients was investigated. Nine patients had an emergency operation and the two who died within 30 days of surgery (mortality rate 2%) had a ruptured aneurysm. Of 88 patients with follow-up data of at least 1 year (mean 3.5 years), 46 received bifurcation grafts and 42 tube grafts. The mean transverse diameter of the aneurysm on ultrasonography was 6.5 cm for straight and 6.1 cm for bifurcation grafts. The mean duration of operation was longer for bifurcation than straight grafts (4.2 versus 3.3h, P< 0.05) and intraoperative blood loss greater for the former (2292 versus 1350 ml, P < 0.05). The incidences of late complications for the two grafts were not different. The only secondary aneurysm repair was a staged procedure on a descending thoracic aortic aneurysm. No postoperative iliac aneurysms were detected by routine physical examination and pelvic ultrasonography in patients receiving straight grafts. Even though there was no preselection of patients by disease status, one surgical team relying on preoperative arteriography successfully replaced 28 of 39 aneurysms (72%) with tube grafts while the other team using primarily intraoperative assessment placed straight grafts in only 14 of 49 patients (29%). In conclusion, straight grafts can be implanted in approximately two-thirds of patients undergoing aortic aneurysm repair with significantly less operating time and blood loss and without increase in the incidence of late iliac occlusion or dilatation. Preoperative arteriography and computed tomography facilitate this decision by identifying occlusive disease or iliac dilatation.
Risk Assessment in Patients Undergoing Carotid Endarterectomy
Authors: Plecha E. J. , King T. A. , Pitluk H. C. , Rubin J. R.
Published: September 2022

Factors that contribute to the outcome of carotid endarterectomy include appropriate patient selection, preoperative medical optimization, meticulous operative technique and postoperative management. This study was designed to evaluate associated medical and operative risk factors with surgical outcomes for 9795 consecutive carotid endarterectomies performed by members of a voluntary regional vascular society. All data were reviewed and subject to a variety of statistical analyses in a blinded retrospective fashion. Factors including sex, increased age (>70 years), cigarette smoking, chronic pulmonary disease and diabetes did not contribute independently to either increased operative neurologic morbidity or mortality rates. Cardiac disease ( P < 0.0001) and chronic renal failure ( P < 0.001) correlated independently with increased operative mortality, while hypertension ( P< 0.05), cardiac disease ( P< 0.01), renal failure ( P< 0.0001), emergency surgery ( P< 0.0001) and advanced neurologic symptoms at the time of operation ( P< 0.0001) were associated with an increased operative stroke rate. In a group of 9021 patients who underwent 9795 carotid endarterectomies with a combined 3.1% incidence of operative neurologic morbidity or mortality (neurologic morbidity, 2.0%; mortality, 1.5%), specific preoperative medical risk factors could be identified. Only cardiac disease and chronic renal failure were associated with both significantly increased operative neurologic morbidity and operative mortality rates.
Thrombectomy and Isolated Limb Perfusion with Urokinase in the Treatment of Phlegmasia Cerulea Dolens
Authors: Sciolaro C. , Hunter G. C. , McIntyre K. E. , Bull D. A. , Parent F. N. , Bernhard V. M.
Published: September 2022

Phlegmasia cerulea dolens is a rare form of deep vein thrombosis. A patient with recurrent episodes of such thrombosis caused by protein C deficiency who developed phlegmasia cerulea dolens is reported. Limb perfusion with urokinase successfully restored venous outflow after unsuccessful attempts at thrombectomy.
Two Cases of Staged Replacement of the Thoracic Aorta Using the ‘Elephant Trunk’ Technique
Authors: Biglioli P. , Spirito R. , Agrifoglio M. , Parolari A. , Pompilio G. , Alamanni F.
Published: September 2022

Two successful cases of staged replacement of multiple aneurysms of the thoracic aorta using the ‘elephant trunk’ technique are described. The management of both cases is discussed.