Uncomplicated postoperative course after transfusion of 176 units of blood products during a single cardiovascular surgery.

A patient with massive perioperative bleeding after repeat aortic surgery for proximal aortic redissection, anastomotic disruption, and prosthetic infection after recent surgery for acute type A aortic dissection was managed with, in total, 176 units of blood products during a 25-hour operating room session. The postoperative course was completely uneventful. Enduring and continuous hemostasis with mediastinal gauze packing, volume replacement, and timely blood product substitution may overcome temporary coagulopathy in desperate surgical circumstances.

[Intraoperative high frequency current ablation as therapy of atrial fibrillation. The Berlin modification]. / Intraoperative Hochfrequenzstromablation zur Therapie von Vorhofflimmern. Die Berlin-Modifikation.

BACKGROUND: The Cox-maze procedure combined with an operation for organic heart disease is highly successful in the elimination of chronic atrial fibrillation. However, it prolongs significantly the aortic cross-clamp and operating time. In this study, a simplified left atrial maze procedure, a short procedure performed using a surgical radiofrequency ablation probe, is added to elective open-heart procedures in patients with atrial fibrillation. PATIENTS AND METHODS: 95 adults with atrial fibrillation (duration, 6 months to 33 years) underwent elective open heart operations (isolated valve procedures or coronary artery bypass grafting, n = 51 patients; combined procedures, n = 44 patients) combined with intraoperative radiofrequency ablation of the left atrium. The postoperative follow-up period ranged from 1 to 24 months (mean, 8 months). Possible predictors for persistent postoperative atrial fibrillation were determined among 40 variables by univariate and multivariate analyses. RESULTS: Intraoperative radiofrequency ablation prolonged the aortic cross-clamp time for 6-14 minutes (mean, 11 minutes). Freedom from atrial fibrillation was 100% intraoperatively, 30% at 1 week after operation, and 84% and 84% at 6 and 12 months postoperatively. The only predictor of postoperative atrial fibrillation was the presence of coronary artery disease (odds ratio, 7.5; 80% confidence interval, 2.24-25.13). CONCLUSIONS: Intraoperative radiofrequency ablation of the left atrium combined with an operation for organic heart disease effectively eliminates atrial fibrillation without significant prolongation of the aortic cross-clamp and operative time. The presence of coronary artery disease decreases the success rate during the first 6 postoperative months.

Delayed retrograde aortic dissection after endovascular stenting of the descending thoracic aorta.

A 66-year-old patient underwent emergency endovascular repair of a descending thoracic aneurysm because of suspected aortic rupture. Two weeks later, a small saccular aneurysm of the aortic arch was treated with open surgery. An unexpected intraoperative finding was retrograde dissection of the aortic arch and of the ascending aorta that was not seen on the postprocedural computed tomographic scans after endografting. The ascending aorta, the aortic arch, and the proximal part of the descending thoracic aorta were successfully replaced with a Dacron graft with deep hypothermia, circulatory arrest, and retrograde cerebral perfusion. Awareness that this life-threatening complication that necessitates extensive cardiovascular surgery can occur not only during or immediately after endovascular stenting of the thoracic aorta but also as much as several days or perhaps even weeks after the procedure is important.