The Egyptian Cardiothoracic Surgeon (ECTS - E-Journal)
Not a member yet
46902 research outputs found
Sort by
Comparative study of tricuspid valve repair using ring vs. synthetic band in severe functional tricuspid valve regurgitation
Full text linkBackground: Functional tricuspid valve regurgitation secondary to left-sided valve disease remains a common problem. There are different surgical techniques for tricuspid valve repair; however, the superiority of one approach over the other has not been proven. Our objective was to compare the short-term results of ring versus synthetic band annuloplasty to repair functional severe tricuspid regurgitation in patients with left-sided valve lesions.
Methods: This retrospective study includes 60 patients who underwent left-sided valve replacement with concomitant tricuspid valve repair for severe tricuspid regurgitation. Patients were divided into group A (n= 30), patients with rigid rings, and group B (n= 30), patients with synthetic bands.
Results: The preoperative demographic and clinical data were non-significant between both groups. In the preoperative data, the tricuspid annular plane systolic excursion (TAPSE) was significantly higher in the ring group (2.84 ± 0.53 vs. 2.3 ± 0.4, P< 0.001). Hospital stay was more prolonged in group B (10.05 ± 1.57 vs. 11.7 ± 2.76 days, P=0.006). There were no differences in other operative and postoperative data between groups. After a six-month follow-up, both groups had no significant difference regarding the clinical data or the degree of tricuspid valve regurgitation.
Conclusion: Tricuspid valve annuloplasty with a rigid ring or synthetic band for tricuspid regurgitation could have a good short-term outcome
Early results of total arterial off-pump coronary artery bypass grafting using bilateral internal mammary arteries
Full text linkBackground: The optimal coronary artery bypass grafting (CABG) technique is still evolving. This study aimed to evaluate the early results of the total arterial off-pump technique using bilateral internal mammary arteries.
Methods: This study was performed from May 2018 to May 2019 at a cardiac surgery center in India. It included 200 patients with coronary artery disease who had off-pump CABG using bilateral internal mammary arteries. The patients had follow-ups for three months. There were 50 females, and the mean age was 50±10 years.
Results: Conversion to on-pump was required in one case (0.5%). The use of complete vein grafts was needed in three cases (1.5%), and vein graft extension was done for two cases (1%). Intra-aortic balloon pump was used in one case (0.5%). Postoperative re-exploration for bleeding was done in two cases (1%), and sternal dehiscence or deep infection occurred in two cases (1%). A pacemaker was used in one case (0.5%), and postoperative need for dialysis occurred in three patients (1.5%). No operative mortality or postoperative stroke was reported. Redo surgery was required in one patient (0.5%).
Conclusions: Off-pump total arterial revascularization technique using bilateral internal mammary arteries could have an acceptable early outcome
Hepatic and gastrointestinal complications after adult cardiac surgery
Full text linkBackground: Gastrointestinal tract (GIT) complications are associated with increased morbidity and mortality after cardiac surgery. Therefore, The goal of this research was to estimate the frequency of GIT and hepatic complications after cardiac surgery and to determine the risk factors for these complications. Additionally, we studied the effect of these complications on the outcomes of surgery.
Methods: This longitudinal study included 139 consecutive patients who underwent elective cardiac surgery. Patients were grouped according to the GIT and hepatic complications into two groups. Postoperative outcomes were compared between the two groups.
Results The mean age was 59.43 years, and 106 patients were males (76%). The GIT and hepatic complications rate was 15.8% (n= 22). Hepatic dysfunction occurred in 8.6% of cases, GIT bleeding in 2.9%, paralytic ileus in 2.2%, fulminant hepatic failure in 2.2%, and GIT bleeding combined with paralytic ileus in 0.7%. The overall mortality was 7.2 % (n= 10). The mortality rate in patients who developed GIT and hepatic complications was 45.5% (n= 10 out of 22 patients). There was statistically significantly higher mortality (10 (45.5%) vs. 0; P= 0.001), cardiac arrest (10 (45.5%) vs. 3 (2.6%); P= 0.001), and reoperation rate (5 (22.7%) vs. 6 (5.1%); P= 0.005) among patients with GIT or hepatic complications.
Conclusion: Patients with hepatic and GIT complications could have higher mortality, morbidity, and longer hospital stay than the non-complicated group
Factors affecting the outcomes after coronary artery bypass grafting
Full text linkBackground: Several factors affect the outcome after coronary artery bypass grafting (CABG). We reported CABG's short- and long-term outcomes and factors affecting the length of hospital stay and event-free survival.
Methods: We conducted a retrospective cohort including 195 consecutive CABG patients from 2010 to 2022. Study endpoints were the length of hospital stay and event-free survival.
Results: Males presented most of our cohort (n= 142, 72.82%); the mean age was 65.19 ±9.20 years. The associated comorbidities were diabetes mellitus (28.72%), peripheral arterial disease (18.45%), cerebrovascular disease (3.08%), and myocardial infarction (52.31%). The prevalence of left-main disease was 28.21%. The mean ejection fraction was 57.27± 13.23, and the median EuroSCORE was 2.96. Nineteen patients had emergency surgery, 65.13% had off-pump CABG, and 84.62% had total arterial revascularization. The median length of hospital stay was 9 days (8- 11). Hospital stay was longer in patients with a history of cerebrovascular disease (β: 1.19 (95% CI: 0.79- 1.60), P<0.001), older age (β:0.16 (95% CI: 0.007- 0.024), P<0.001), and diabetics (β: 0.29 (95% CI: 0.12- 0.46), P= 0.001). The risk of events increased in patients with previous cardiovascular disease (P= 0.025), peripheral arterial disease (p<0.001), and patients with diabetes (P= 0.025).
Conclusion: Patients' specific risk factors and comorbidities were the main determinants of the length of hospital stay and long-term outcomes after coronary artery bypass grafting
Modified Single-Patch Technique Versus Two-Patch Technique in Infants with Complete Atrioventricular Septal Defect
Full text linkBackground: There are many techniques in repairing complete atrioventricular septal defect including: double patch technique, classic single patch technique and modified single patch technique. It's still debated which of these techniques is superior to the other one, our objective was to contrast the outcomes following surgery between the modified single patch and double patch techniques for repair of complete atrioventricular septal defect.
Methods: This study includes 100 infants who underwent complete atrioventricular septal defect repair. Individuals were split into patients repaired with modified single patch as group A (n= 50), and patients repaired with double patch as group B (n= 50).
Results: Group B showed significantly higher Cardiopulmonary bypass time (110 ±12 vs. 88 ±8 min, P < 0.001) Aortic cross clamp time (81 ±7 vs. 61 ±5 min, P < 0.001), ICU stay (10 ±1 vs. 9 ±1 day, P < 0.001), hospital stay (17 ±2 vs. 15 ±1 day, P < 0.001), and drainage amount (310 ±98 vs. 194 ±80, P < 0.001). No changes observed among groups of the study in other operative or postoperative statistics.
Conclusion: Modified single-patch repair and two-patch repair did not yield significantly different results in the total correction of atrioventricular septal defects
Thoracoscopic excision of asymptomatic posterior mediastinal ganglioneuroma. A case series study
Full text linkBackground
Posterior mediastinal ganglioneuroma is the most frequent type of neurogenic tumors, and usually it is asymptomatic. The surgical approach to excise it may differ from center to center based on the surgeon's experience as well as the size of tumor. We aim to present our center's experience and short-term outcomes in surgical excision of posterior mediastinal ganglioneuroma.
Methods
This retrospective case series study, from June 2019 till December 2022, included 9 asymptomatic patients with mean age of 31± 5 years who expressed lesion in the posterior mediastinum. The mean size of the tumor was 5.3±3.6 cm in maximal dimensions.
Results
There were 7 males and 2 females with mean age was 31± 5 years, the excision by video-assisted thoracoscopy (VATS) was employed in 8 patients and conventional thoracotomy was carried out in 1 case. The mean operative time was 57±14 minutes with mean operative blood loss 50±10 ml. The mean postoperative chest tube drainage was 120±80 ml and no complications related to the procedures were observed. The average time of hospital stay after VATS treatment was 2 days, while after thoracotomy it was 5 days and patient suffered from ptosis that eventually recovered after 1 month with supportive treatment. Histopathological examination confirmed benign nature of ganglioneuroma in all cases.
Conclusions
Thoracoscopic excision of asymptomatic posterior mediastinal neurogenic tumor is safe, feasible and reduces postoperative pain, however, open technique might be considered for large-sized tumor to minimize the possible complications
Left internal mammary on-lay patch vs. saphenous vein patch in reconstructing diffusely diseased left anterior descending artery
Full text linkBackground: Several operative techniques were described to reconstruct the diffusely diseased left anterior descending coronary artery (LAD). The superiority of the left internal mammary artery (LIMA) vs. the saphenous vein patch is controversial in LAD reconstruction. Thus, this study compared LIMA on-lay patch vs. saphenous vein patch in reconstructing diffusely diseased LAD artery.
Methods: This study was conducted between June 2020 and May 2022 including 60 patients with a diffusely diseased LAD. LIMA patch was used in 30 patients (Group I) and saphenous vein patch in 30 patients (Group II) without endarterectomy. Males presented 85%; the mean age was 56.68 ± 6.44 years. The mean patch length in the LIMA group was 4.48±0.87 cm and 4.60± 0.93 cm in the saphenous vein group.
Results: The mean aortic cross-clamp and cardiopulmonary bypass times were 66.80± 19.93 and 108.00± 25.74 minutes in the LIMA group and 84.40± 30.65 and 132.53± 45.41 minutes in the venous Group (P= 0.011 and 0.013, respectively). The mean intensive care unit stay was 50.40 ± 38.65 hours in Group I and 92.00± 51.62 hours in Group II (P˂ 0.001). Four patients (13.3%) needed an intra-aortic balloon pump (IABP) in Group I, and 11 patients (36.7%) in Group II (P= 0.037). Postoperative low cardiac output occurred in 13.3% of Group I and 53.3% in Group II (P= 0.001). Postoperative atrial fibrillation occurred in 13.3% of Group I, while in Group II was 33.3% (P= 0.067). The renal complications were 3.3% in Group I and 16.7% in Group II (P= 0.085). Two patients (6.7%) were complicated with bleeding in Group I, and nine (30.0%) in Group II (P= 0.02). The postoperative ejection fraction was 58.17± 5.25% in Group I and 53.3± 5.23% in Group II (P= 0.001). On the first postoperative day, the creatine kinase-myoglobin binding level was 61.73± 30.19 IU/L in Group I and 92.63± 45.88 IU/L in Group II (P= 0.004). Hospital mortality occurred in one patient (3.3%) in Group I and two in Group II (6.7%) (P˃ 0.99).
Conclusion: LAD reconstruction using the LIMA patch could have better early outcomes than the saphenous vein patch
Phrenic palsy after pediatric cardiac surgery: what is the best modality of management?
Full text linkBackground: Pediatric cardiac surgery is one of the most common causes of diaphragmatic palsy (DP) in infants and young children. The main target in managing a patient with DP is to preserve the respiratory function. Surgical diaphragmatic plication is widely used surgical treatment of DP nowadays especially in infants than in young children. Tracheostomy was suggested also to facilitate the suction of the chest and decrease the pulmonary complications. Thus, the aim of this study was to detect the effect of early intervention to correct the phrenic palsy either by diaphragmatic plication, Tracheostomy or both in pediatric cardiac surgery patients.
Methods: This is a retrospective study on pediatric patients who had cardiac surgical procedures between June 2008 and Dec 2018. There were 3706 patients had been operated at different age groups of whom 42 patients developed DP. The patients were divided into four groups according to type of treatment: Group A for conservative treatment, Group B for diaphragmatic plication only, Group C for tracheostomy only, and Group D for tracheostomy and plication.
Results: The mean age of the studied group was 19.7 ±23 . There was male predominance (78.6 %). Timing of tracheostomy in days was as 30 ±7.1, and 31.8 ±5.4 in group C, and D respectively. Timing of plication was as 10 ±8.3, and 11.1 ±7.6 in group B, and D consequence
Conclusion: The least sepsis recorded for patients with both tracheostomy and DP, delayed surgical intervention led to higher mortality and more sepsis recorded as in conservative technique
Off versus On pump coronary artery bypass grafting; a single-center experience
Full text linkBackground: The debate about on-pump vs. off-pump coronary artery bypass grafting (CABG) continues. The present study compared the short-term outcomes after off-pump vs. on-pump CABG.
Methods: The study was conducted on 67 patients who underwent CABG from 2021 to 2022. Patients were divided into two groups according to the CABG technique. Group 1 included 33 patients who underwent off-pump CABG, and Group 2 included 34 patients who underwent on-pump CABG. The study outcomes were operative time, hospital complications, and mortality.
Results: On-pump patients were significantly older than off-pump patients (64.78±7.12 vs. 59.09±6.29; p= 0.004). There were no differences in comorbidities, presenting symptoms, or ejection fraction between groups. Operative time was significantly shorter in off-pump patients (227.47±13.73 vs. 321.12±27.49; p< 0.001). Blood transfusion was lower in off-pump patients (1.06± 0.311 vs. 1.79± 0.25; p< 0.001). Bleeding was lower in off-pump patients (0.81±0.13 vs. 0.91±0.20 ml, p= 0.01). Off-pump patients had significantly shorter ICU (3.5±2.6 vs. 4.9±4.7; p<0.001) and hospital stay (7.6±4.8 vs. 9.5±6.1; p<0.001). No patient had reexploration for bleeding, wound infection, or mortality in our series. One patient had renal impairment in the on-pump group (p>0.99).
Conclusion: Off-pump and on-pump CABG seem to be safe approaches for managing coronary artery disease in our institution. Off-pump could be superior to on-pump CABG regarding shorter ICU and hospital stay. Studies with data from a large number of patients are recommended
The effect of gender on short and long-term outcomes of coronary artery bypass grafting
Full text linkBackground: There is no consensus on the effect of gender on the outcomes after coronary artery bypass grafting (CABG). Thus, this study aimed to describe gender differences in CABG and evaluate the impact of gender on the short and long-term outcomes after CABG.
Methods: This study was conducted on 195 CABG patients. The patients were grouped according to gender into two groups: males (n= 142) and females (n= 53). Study endpoints were hospital outcomes (drainage, myocardial infarction (MI), neurological and renal complications, sternal wound infection, and mortality) and the long-term composite endpoint of recurrent angina, myocardial infarction, repeat revascularization, and mortality.
Results: Male patients were significantly younger than females (P= 0.025) and had a significantly lower Euro SCORE (P<0.001). The number of distal anastomoses was significantly more in males, and total arterial revascularization was more commonly used in males (P= 0.002 for both). Postoperative drainage was substantially higher in males than in females (P<0.001). There were no differences in other postoperative complications between groups. The median follow-up duration for males was 58 (47- 67) months vs. 61 (48- 65) months for females. Recurrent angina occurred in ten males (7.04%) vs. five females (9.43%) (log-rank P= 0.547). MI during follow-up occurred in 3 males (2.11%) and none in females. Coronary reintervention occurred in three males (2.11%) vs. three females (5.66%) (log-rank P= 0.614). Five males had follow-up mortality (3.52%) vs. two females (3.77%) (Log-rank P= 0.957). The composite endpoint of death, MI, recurrent angina, and coronary reintervention occurred in 16 males (11.27%) vs. eight females (15.09%) (Log-rank P= 0.464).
Conclusions: This study revealed that there could be no difference in the outcomes of coronary artery bypass grafting between males and females