The Egyptian Cardiothoracic Surgeon (ECTS - E-Journal)
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Early Outcomes of Re-Exploration for Bleeding After Elective Cardiac Surgeries in Adult Patients
No full textBackground: Re-exploration for bleeding is a serious complication following elective cardiac surgery, consistently associated with increased morbidity, mortality, prolonged hospital stay, and greater use of healthcare resources. We aimed to investigate the causes of re-exploration for bleeding in adult cardiac surgery patients, determine its impact on the outcomes, and analyze the predictors of mortality.
Methods: A prospective observational study was conducted on 200 consecutive adult patients who underwent exploration for bleeding during 1450 elective cardiac surgeries between July 2024 and March 2025.
Results: The mean age was 49.18 ± 12.71 years, and 26.5% were females. Comorbidities included diabetes (22%), hypertension (42.5%), and smoking (58.5%). Mean preoperative EF was 58.18 ± 6.54%. Procedures included CABG (43%), mitral valve replacement (22%), double valve replacement (17.5%), aortic valve replacement (15%), and Bentall (2.5%). Mean cardiopulmonary bypass and cross-clamp times were 120.01 ± 35.32 and 88.31 ± 23.90 minutes, respectively. Early mortality was 7.5%. Major complications included shock (4.5%), massive transfusion (18%), and renal failure (2%). Most re-explorations occurred within 6–12 hours (47%). Bleeding was surgical in 81.5% and medical in 18.5%. Multivariable regression identified prolonged mechanical ventilation as a significant predictor of early mortality (OR = 1.226, p = 0.016).
Conclusion: Surgical causes predominate in postoperative bleeding, though medical causes remain significant. Bleeding is associated with significant morbidity and mortality. Preventive surgical measures and multidisciplinary management are essential to improve outcome
The Operative Correction of Pectus Deformities: A Prospective Cohort Study
No full textBackground: Pectus deformities represent the most common congenital chest wall abnormalities, significantly impacting both physiological function and psychological well-being of affected patients. While multiple surgical approaches exist, the outcomes of surgical repair remain a subject of ongoing investigation. The objectives of this study were to evaluate the psychological impacts of pectus deformities with assessment of psychological satisfaction of the patient and his family post operative and assess improvements of physiological impacts of these deformities post operative
Methods: This prospective cohort study was conducted at xxxxx from 2022 to 2025. Fifty patients with pectus deformities underwent surgical correction using either the Modified Ravitch procedure (n=28, 56%) or the Nuss procedure (n=22, 44%). Outcomes included postoperative assessment scores (poor, fair, good, excellent), hospital stay duration, complications, and patient satisfaction.
Results: The study population consisted of 38 males (76%) and 12 females (24%) with a mean age of 14.8 ± 1.9 years. Pectus excavatum was the predominant deformity (86%, n=43), with pectus carinatum comprising 14% (n=7). Severity distribution showed 26% severe cases, with the remainder classified as moderate or mild. The overall excellent outcome rate was 42% (21/50), with 50% achieving good outcomes. Median hospital stay was 9 (8- 10) days, showing positive correlation with Haller index (r=0.33, p=0.026). The recurrence rate was low at 4% (2/50), and psychological satisfaction was achieved in 94% of patients.
Conclusions: Surgical techniques for pectus repair demonstrated high success rates with low morbidity. The Nuss procedure and Modified Ravitch procedure remains a reliable option with good to excellent outcomes in most cases
Comparison Between the Impact of Antegrade Versus Retrograde Arterial Cannulation Techniques on the Early Outcome of Patients with Type A Aortic Dissection
No full textBackground: Acute type A aortic dissection represents one of the most critical emergencies in cardiovascular surgery, demanding rapid diagnosis and prompt operative intervention. Despite significant advances in surgical strategies and perioperative management, morbidity and mortality remain high, and the choice of cannulation technique continues to generate debate among surgeons worldwide.
Methods: It is a prospective non randomized comparative study aimed to compare the early outcome of repair of type A aortic dissection using different cannulation techniques by sorting them into two groups, Group 1, The antegrade group (30 patients) in which axillary, innominate and central cannulation was done and Group 2, the retrograde group (30 patients) in which femoral cannulation was done from March 2021 till September 2025.
Results: The mean age was 56.2 ± 11.4 for group 1 and 58.6 ± 10.7 for group 2. The in-hospital mortality was 2 patients (6.7%) in the antegrade group versus 5 patients (16.7%) in the retrograde group while the 30-day mortality was 3 patients (10%) in the antegrade group versus 6 patients (20%) in the retrograde group.
Conclusion: Antegrade and retrograde cannulation both remain safe and effective strategies in managing acute type A aortic dissection. Antegrade approaches showed meaningful advantages in procedural efficiency, cerebral protection, and recovery outcomes. When pathology and surgical expertise permit, antegrade cannulation should be favored. while retrograde access remains a reliable option in emergency cases
Conventional versus Minimally Invasive Mitral Valve Surgery: A Comparative Analysis of Clinical Outcomes and Patient Recovery
Full text linkBackground: The evolution of surgical techniques has led to increased adoption of minimally invasive mitral valve surgery, yet comprehensive comparative analyses of clinical outcomes remain essential for optimal patient selection and surgical planning. This study compared the clinical outcomes, operative characteristics, and postoperative recovery parameters between conventional and minimally invasive mitral valve surgery.
Methods: This prospective cohort study analyzed 100 patients undergoing mitral valve repair (MVR), with 50 patients in each group (conventional MVR n=50, minimally invasive MVR n=50).
Results: Significant demographic differences were observed between groups, with the conventional group being older (52.32±10.19 vs 42.68±11.95 years, p<0.001) and having lower rates of hypertension (22% vs 42%, p=0.032), chronic kidney disease (14% vs 42%, p=0.002), and smaller left atrial dimensions (4.3 vs 4.65 cm, p<0.001). The minimally invasive group demonstrated significantly longer cardiopulmonary bypass times (100 vs 136 minutes, p<0.001) and ischemic times (64 vs 79 minutes, p<0.001). However, the minimally invasive approach was associated with significantly reduced intensive care unit stay (4 vs 3 days, p<0.001), shorter hospital length of stay (9 vs 8 days, p<0.001), and decreased ventilation time (9 vs 7 hours, p<0.001). However, the conventional approach had markedly improved pain scores, with 2% experiencing severe pain compared to 30% in the minimally invasive group (p<0.001). Postoperative complications showed comparable bleeding rates (10% vs 12%, p=0.749) and wound infections (8% vs 2%, p=0.362), though the minimally invasive group had higher rates of pleural effusion (2% vs 26%, p=0.001).
Conclusions: Minimally invasive mitral valve surgery demonstrates comparable safety profiles to conventional approaches while offering significant advantages in postoperative recovery, including reduced hospital stay and shorter ventilation requirements. However, the technique requires longer operative times and may be associated with specific complications such as pleural effusion. These findings support the continued development and selective application of minimally invasive techniques in mitral valve surgery
Conventional left atriotomy versus the superior septal approach for mitral valve replacement: a clinical controlled randomized trial
Full text linkBackground: The most effective techniques to enhance mitral valve visualization while reducing risks associated with the procedure are still debatable. Therefore, this study compared the results of conventional left atriotomy (LA) with those of the superior septa (SS) approach for mitral valve replacement (MVR).
Methods: This randomized controlled clinical trial included patients who underwent MVR between 2024 and 2025. The participants were randomly assigned to: Group A (n=27) included patients who underwent MVR through conventional LA, and Group B (n=33) included patients who had a SS incision for MVR.
Results: The mean age in Group A was 43.04±9.02 years, whereas that in Group B was 47.33±9.92 years (P=0.09). There were no differences in sex or smoking status between the groups (P=0.73 and 0.84, respectively). No statistically significant differences were observed in the preoperative clinical, echocardiography or laboratory data. Cardiopulmonary bypass and ischemic times were shorter in patients with the SS approach (87±12 vs. 81±8 min, P=0.048 and 70±10 vs. 65±6 min, P=0.01, respectively). The vasoactive inotropic score was significantly lower in patients in Group A (P=0.04). Mechanical ventilation [9 (7–12) vs. 12 (9–12) h, P=0.02], ICU stay [3 (3–5) vs. 4 (3–5) days, P=0.09] and hospital stay [9 (8–11) vs. 11 (9–12) days, P=0.01] were shorter in patients in Group A. There were no differences in postoperative atrial fibrillation, heart block, superficial wound infection, or re-exploration for bleeding between the groups. No significant difference in changes in the ejection fraction (β: -0.002 (95%CI: -0.03-0.028), P=0.86) left atrial diameter (β: -0.11 (95%CI: -0.29-0.07), P=0.23) end-systolic diameter (β: -0.06 (95%CI: -0.27-0.14), P=0.55) between the groups.
Conclusions: Both LA and the SS approach are viable options for MVR. A SS approach was associated with shorter operative times; however, LA was associated with faster postoperative recovery, with no difference in the complication rate. Further studies with large sample sizes and longer follow-up periods are warranted
Early and Mid-Term Outcomes of Quadruple Attack Technique for Sternal Osteomyelitis and Chronic Sinus Formation After Cardiac Surgery
No full textBackground: Sternal osteomyelitis with chronic sinus tract after cardiac surgery is a serious complication, and early management is crucial. The aim of this study is to report our experience with the “Quadruple Attack” technique, which involves intravenous (IV) antibiotics, surgical debridement, vacuum therapy, and hyperbaric oxygen sessions for management of this condition.
Methods: This prospective study was performed at Cardiothoracic Surgery Department, Ain Shams University in Egypt between March 2020 and August 2024 and included 52 patients who underwent the quadruple attack technique for the management of sternal osteomyelitis with a chronic sinus tract.
Results: The mean age was 49.6 ± 9.23 years. 12 (23.1%) patients were hypertensive, while 17 (32.7%) of patients had diabetes. 44 (84.6%) of patients had satisfactory healing, 8 patients (15.4%) had re-sternotomy and resection of the sinus tract, while 5 patients (9.6%) required sternectomy and musculocutaneous flaps.
Conclusion: Our quadruple attack technique for the management of sternal osteomyelitis with a chronic sinus tract after cardiac surgery is promising, with encouraging mid-term outcomes in selected patients with a non-dehisced sternum
Levosimendan as a rescue therapy for low output syndrome after cardiac sugery
Full text linkBackground: The calcium sensitizer levosimendan has been shown to improve outcomes in patients with low cardiac output syndrome (LCOS) following cardiac surgery. We assessed its efficacy when used as a rescue therapy in the postoperative setting rather than as a prophylactic preoperative treatment.Methods: According to our institutional protocol, 18 patients with LCOS that persisted despite conventional inotropic therapy received a 24-hour infusion of levosimendan at 0.1 μg/kg/min. Hemodynamic parameters and clinical outcomes were monitored and statistically analyzed.Results: Ejection fraction (EF) increased significantly from 29 ± 5% to 41.6 ± 2.7 within 48 hours of initiating levosimendan. This improvement was accompanied by a significant increase in cardiac output from 3.7 ± 0.5 L/min to 5.6 ± 0.8 L/min after 48 hours, along with significant dose reductions in concomitant vasopressors and inotropes. Inotropic support was significantly reduced at the 12-hour assessment compared to the immediate postoperative period and continued to decline over the 48-hour observation window. The norepinephrine dose showed a significant reduction at 48 hours. The overall perioperative mortality was 11%.Conclusion: Our study suggests that levosimendan is an effective rescue therapy for managing LCOS postoperatively. Its administration should be part of a controlled regimen that avoids unnecessary delays and allows for the concurrent use and monitoring of conventional inotropes
Outcome of Bilateral Thoracoscopic Sympathectomy for Patients with Primary Focal Hyperhidrosis, Sohag University Hospital Experience
No full textBackground: Primary focal hyperhidrosis (PFH) causes excessive sweating and significant quality-of-life impairment, with symptoms aggravated by emotional stress and anxiety. Conservative treatments often provide only temporary relief, making endoscopic thoracic sympathectomy (ETS) the definitive option, though traditional T2 interruption carries a high risk of compensatory sweating. Lower T3–T4 interruption may reduce this complication, but regional data are lacking. This study assesses the efficacy and safety of T3–T4 bilateral thoracoscopic sympathectomy in Egyptian patients.
Methods: This prospective study included 20 patients (≥16 years) with severe PFH (HDSS ≥3) unresponsive to conservative therapy, excluding those with severe cardiopulmonary disease or bleeding disorders. Diagnosis was confirmed clinically and with Minor starch–iodine testing. All patients underwent bilateral thoracoscopic T3–T4 sympathicotomy. Outcomes included symptom resolution, compensatory sweating, QoL (DLQI), complications, and recurrence, with follow-up up to 6 months.
Results: Twenty patients (mean age 20.9 years; 65% male) with severe PFH underwent bilateral thoracoscopic T3–T4 sympathectomy. All procedures were completed safely with minimal blood loss and rapid recovery. HDSS scores dropped from a median of 4 to 0 (p < 0.001), with high patient satisfaction (median 10/10). Compensatory sweating occurred in 15% (mild/moderate), and one patient (5%) had recurrence. Functional and occupational outcomes improved in nearly all patients, sustained at a mean follow-up of 8.6 months.
Conclusion: T3–T4 bilateral thoracoscopic sympathectomy is a safe, effective surgical option for severe PFH. It produces excellent symptom control, minimal morbidity, high patient satisfaction, and acceptable levels of compensatory sweating. With continued refinement of technique and patient selection, T3–T4 BTS can be considered a reproducible standard of care in resource-constrained settings
Right Ventricular Dysfunction Post-Surgical Repair of Fallot Tetralogy in Pediatric Age Group: Predictor Factors Analysis
Full text linkBackground: Right ventricular (RV) dysfunction is often detected after Tetralogy of Fallot (TOF) repair. We aimed to analyze the preoperative, intraoperative, and postoperative risk factors for RV dysfunction and to correlate them to the surgical technique used in the repair.
Methods: This prospective cohort study included 26 pediatric patients with TOF. The participants were divided into two groups based on RV dysfunction. Group A included patients with RV dysfunction, and Group B included patients without RV dysfunction. Each patient was assessed clinically and via echocardiography and cardiac magnetic resonance. Participants were followed for 6 months.
Results: The incidence of RV dysfunction was 30.8% of patients. Compared to group B, patients in group A had significantly low preoperative oxygen saturation (p=0.011), high Right ventricular outflow tract pressure gradient (RVOT PG) (p=0.03), operative transannular patch (p=0.011), prolonged intubation time (p=0.017), and pediatric intensive care unit stay (p=0.001), high incidence of inadequate urine output (p=0.014), prolonged inotropic use (p=0.02) as well as low postoperative tricuspid annular plane systolic excursion (TAPSE) (p˂0.001) and fractional area change (FAC)(p˂0.001), and high RVOT pressure gradient (p˂0.001). However, regression analysis showed no statistical correlation between these variables and RV dysfunction.
Conclusion: Physicians should consider low preoperative oxygen saturation, high RVOT PG, operative transannular patch, long intubation time and pediatric intensive care unit stay, high incidence of inadequate urine output, prolonged inotropic use as well as low postoperative TAPSE and FAC, and high RVOT pressure gradient as risk factors for RV dysfunction after TOF repair in pediatrics
Pigtail Drainage of Iatrogenic Pneumothorax or Hemothorax: Is a Sufficient Procedure?
Full text linkBackground: Pigtail catheters, originally used by cardiologists to drain chronic pericardial effusions, have been adapted for pleural drainage. This study aimed to evaluate the effectiveness of pigtail catheterization as an alternative to chest tube in the management of iatrogenic pneumothorax and hemothorax.
Methods This prospective interventional study included 50 adult patients (>18 years) diagnosed with iatrogenic pneumothorax (Group A, n=25) or iatrogenic hemothorax (Group B, n=25).). All patients underwent clinical evaluation, including history taking, clinical examination, imaging procedures [chest CT and chest x-ray], and laboratory investigations.
Results: Group A had a significantly shorter hospital stay than Group B (P < 0.001). Regarding catheter-related complications, Group B had a significantly higher failure rate (P < 0.001). Univariate analysis revealed that hemothorax, chronic liver disease, central venous line insertion, and true cut biopsy from a central mass were significant risk factors for failure of the pigtail catheter.
Conclusion: Pigtail catheter is more efficient in the management of iatrogenic pneumothorax than hemothorax. It is preferred to initially apply conventional chest tube in the latter to avoid the high failure rate of these small catheters