Late Iatrogenic Coronary Sinus Hematoma During Cardiac Surgery.

Retrograde cardioplegia is commonly used in cardiac surgery to induce cardioplegic arrest. However, this method could be potentially associated with coronary sinus injuries, which can be fatal or extremely difficult to manage. This report describes the conservative management of an iatrogenic coronary sinus hematoma by daily transthoracic echocardiography and weekly computed tomography follow-up.

Partially Resorbable Mesh Inclusion between Dissected Layers during Surgical Repair of Aortic Dissection.

Surgical management of aortic dissection is technically challenging for different reasons. Reapproximation of dissected layers because of fragility of the dissected aortic wall layers is of major concern. Many techniques have been described to restore the integrity of aortic wall.

Direct proximal right subclavian artery cannulation during surgery of the thoracic aorta.

Objective: To evaluate outcomes of single sternum access for right subclavian artery cannulation without infraclavicular incision in surgery of the thoracic aorta.

Methods: Between January 2015 and December 2019, 44 consecutive patients underwent surgery of the thoracic aorta with cannulation of the right subclavian artery, after sternotomy and before pericardiotomy, through a direct percutaneous cannula with a single access without additional infraclavicular skin incision. The indication for surgery was type A acute aortic dissection in 29 patients (65.

Optimal Management of Patients Treated With Minimally Invasive Cardiac Surgery in the Era of Enhanced Recovery After Surgery and Fast-Track Protocols: A Narrative Review.

Objectives: Use of minimally invasive cardiac surgery (MICS) is increasing, but to exert its maximum effect on patient outcomes, MICS must be coupled with improved perioperative management, including the Enhanced Recovery after Surgery (ERAS) and fast-track protocols. This study aimed to evaluate the impact of ERAS and fast track in this context.

Design: NARRATIVE REVIEW: The authors performed a narrative review that included patients treated with MICS and patients treated with the ERAS/fast-track protocols in the MEDLINE/PubMed database.

Right subclavian artery cannulation for aortic dissection surgery, without infraclavicular incision.

The choice of arterial cannulation strategy for acute type A dissection surgery remains a controversial  issue and a subject of great debate because of its impact on clinical outcomes. A review of retrospective studies shows that surgeons are tending to switch from a retrograde to an antegrade perfusion strategy. Innominate artery cannulation has a number of advantages when compared to other cannulation techniques; however when the vessel is dissected, the proximal right subclavian artery can be used for arterial return.

Percutaneous or Side-Arm Graft Right Subclavian Artery Cannulation via Median Sternotomy.

Several cannulation sites alternative to the ascending aorta, such as femoral, right axillary, carotid, innominate artery, and, less commonly, apical sites, have been proposed. Cannulation of the right subclavian artery, through sternotomy, is one possible means of establishing cardiopulmonary bypass, hence avoiding a second surgical incision. In our experience, cardiopulmonary bypass flow was adequate and circulatory arrest with antegrade cerebral perfusion was successfully performed in all cases.

One-stage transmediastinal surgical approach for extensive aortic pathology.

"One-stage" transmediastinal replacement of the thoracic aorta provides an alternative treatment to single or multiple stage hybrid procedures for patients with ascending, arch, and descending thoracic aorta aneurysm. The patient is placed on bypass and cooled. During circulatory arrest, after surgical treatment of the aortic valve and root where appropriate, the entire ascending aorta is excised and the transverse arch is opened longitudinally.

New ultrasonic device for internal thoracic artery harvesting.

The internal thoracic artery skeletonization method typically involves careful dissection with electrocautery. However, skeletonization using harmonic technology is safer than the conventional method. Ultrasonic shears may be faster than traditional methods, and may optimize the quality of skeletonized grafts during harvesting, preserving their functional and structural conduit integrity, and facilitating harvesting of the bilateral internal thoracic artery.

Takotsubo cardiomyopathy after minimally invasive mitral valve surgery: clinical case and review.

A sudden, unexpected, reversible, severe left ventricular dysfunction, mimicking an acute myocardial infarction without demonstrable obstructive coronary artery stenosis, was first recognized in Japan in 1990 and originally termed takotsubo cardiomyopathy. In 2006, the American Heart Association included takotsubo cardiomyopathy into its classification of primary acquired cardiomyopathy. The true incidence of takotsubo cardiomyopathy in the community is difficult to estimate.

Endoscopic Saphenous harvesting with an Open CO2 System (ESOS) trial for coronary artery bypass grafting surgery: study protocol for a randomized controlled trial.

Background: In coronary artery bypass grafting surgery, arterial conduits are preferred because of more favourable long-term patency and outcome. Anyway the greater saphenous vein continues to be the most commonly used bypass conduit. Minimally invasive endoscopic saphenous vein harvesting is increasingly being investigated in order to reduce the morbidity associated with conventional open vein harvesting, includes postoperative leg wound complications, pain and patient satisfaction.

Safety and effectiveness of low dosing of double antiplatelet therapy during long-term left ventricular support with the INCOR system.

Adverse events due to anticoagulation and antiplatelet therapy during left ventricular assistance device (LVAD) support are very common, and every effort must be made to reduce their impact. We report our experience using a low dose of double antiplatelet therapy for patients provided with the INCOR LVAD system as a bridge to transplantation. Twelve patients (10 males, 35-60 years old) with acute or end-stage heart failure were included in this study.

Hybrid repair of aortic arch aneurysm in high-risk patients.

Objectives: Morbidity and mortality after conventional surgery of aortic arch aneurysms remain high. Alternative techniques are the subject of this report.

Methods And Results: Open surgery requires cardiopulmonary bypass and hypothermic circulatory arrest.

Mesothelial cyst of the pericardium, absent on earlier computed tomography.

Pericardial cysts are benign intrathoracic lesions that are considered to be congenital. They are usually found incidentally upon chest radiography and typically cause few symptoms. Their true incidence is unknown.

Extracorporeal membrane oxygenation as a "bridge to recovery" in a case of myotomy for myocardial bridge complicated by biventricular dysfunction.

The incidence of cardiac dysfunction after routine cardiac surgical procedures is quite high (3-5%), but the majority of patients improve using inotropic drugs or intraaortic balloon counterpulsation. However, approximately 1% of these patients do not benefit from using these supports, and they need more invasive strategies, such as ventricular assist devices. Extracorporeal membrane oxygenation (ECMO) is one of them, and it offers biventricular support, can be managed very easily and is one of the cheapest devices.

Unexpected long durability of a low-profile porcine Liotta bioprosthesis in mitral position.

We report a case in which replacement of a low-profile porcine Liotta bioprosthesis was required 21 years after initial implantation. The patient underwent mitral valve replacement with a 28-mm Liotta bioprosthesis in 1985 for mitral stenosis. Twenty-one years later, severe mitral regurgitation was detected at echocardiography and mitral valve reoperation combined with tricuspid annuloplasty was successfully performed.

Acute bioprosthetic thrombosis immediately after aortic valve replacement.

We present the case of a 72-year-old woman referred for dyspnea and vertigo when admitted to the hospital with a diagnosis of aortic stenosis. She had hypertension with previous deep venous thrombosis with no known hypercoagulable diathesis. She underwent aortic valve replacement with a Carpentier-Magna bioprosthesis without intraoperative complications; selective cardioplegia before aortic wall suture confirmed that coronary ostia were free.

Patent foramen ovale and ascending aortic aneurysm with platypnea-orthodeoxia syndrome.

Platypnea-orthodeoxia is a rare syndrome characterized by dyspnea induced by the upright position and relieved by supine position and an arterial deoxygenation increased by the upright position which improves during recumbency. Several anatomical factors that can alter the atrial anatomy and facilitate shunting through an interatrial defect have been related with this syndrome. In many cases, this syndrome has been associated with patent foramen ovale and right-to-left shunt.