Cardiopulmonary resuscitation at operating room entry in acute aortic dissection type A patients: is surgery contraindicated?

Background: This study aimed to compare the short-term outcomes of surgical treatment for acute type A aortic dissection between patients undergoing cardiopulmonary arrest at the time of entry into the operating room and patients who received successful preoperative cardiopulmonary resuscitation before entering the operating room or patients who had cardiopulmonary arrest on the operating room table after entering the operating room without cardiopulmonary arrest. In the present study, we focused on the circulatory status at the time of entering the operating room because it is economically and emotionally difficult to cease intervention once the patient has entered the operating room, where surgeons, anesthesiologists, nurses, and perfusionists are already present, all necessary materials are packed off and cardiopulmonary bypass have already been primed. Methods: Twenty (5.5%) of 362 patients who underwent surgical treatment for acute type A aortic dissection between January 2016 and March 2022 had preoperative cardiopulmonary arrest. To compare the early operative outcomes, the patients were divided into the spontaneous circulation group (n = 14, 70.0%) and the non-spontaneous circulation group (n = 6, 30.0%) based on the presence or absence of spontaneous circulation upon entering the operating room. The primary endpoint was postoperative 30-day mortality. The secondary endpoints included in-hospital complications and persistent neurological disorders. Results: Thirty-day mortality was 65% (n = 13/20) in the entire cohort; 50% (n = 7/14) in the spontaneous circulation group and 100% (n = 6/6) in the non-spontaneous circulation group. The major cardiopulmonary arrest causes were aortic rupture and cardiac tamponade (n = 16; 80.0%), followed by coronary malperfusion (n = 4; 20.0%). Seven patients (50.0%) survived in the spontaneous circulation group, and none survived in the non-spontaneous circulation group (P = .044). Five survivors walked unaided and were discharged home; the remaining two were comatose and paraplegic. Conclusions: The outcomes were extremely poor in patients with acute type A aortic dissection who had preoperative cardiopulmonary arrest and received ongoing cardiopulmonary resuscitation at entry into the operating room. Therefore, surgical treatment might be contraindicated in such patients.

Fulminant respiratory failure due to severe pneumothorax after re-do coronary artery bypass grafting treated with veno-venous extracorporeal membrane oxygenation.

This case report details the management of a 79-year-old man who developed massive postoperative pneumothorax following redo coronary artery bypass grafting due to severe lung adhesions. We successfully treated the patient using veno-venous extracorporeal membrane oxygenation without femoral cannulation, allowing for early rehabilitation initiation. Veno-venous extracorporeal membrane oxygenation is a reasonable option for cases of severe respiratory failure due to pneumothorax with lung destruction caused by re-sternotomy during re-do cardiac surgery.

A case of non-bacterial thrombotic endocarditis on the aortic valve following coronary angiography.

Nonbacterial thrombotic endocarditis (NBTE) on the aortic valve involves fibrin and platelet aggregate formation, potentially leading to embolic events. We present a case of NBTE on the aortic valve following coronary angiography (CAG) in a 54-year-old man with multiple comorbidities. Surgical thrombectomy was performed owing to acute cerebral infarcts. This case highlights the significance of considering that mechanical trauma from catheterization during CAG can trigger thrombus formation.

[Early Outcomes and Indications for Surgical Intervention of Preoperative Atrial Fibrillation].

BACKGROUND: This study investigates short-term outcomes following surgical interventions for atrial fibrillation (Af), including the Cox-maze Ⅳ procedure (maze procedure) and pulmonary vein isolation (PVI), performed concurrently with other cardiac surgeries. Additionally, we aim to determine the indications for surgical intervention for Af. METHOD: We retrospectively studied a total of 1,580 patients, out of which 274 had preoperative Af, that underwent cardiac surgery between January 2015 and April 2023. Patients who underwent emergency surgery, died in the hospital postoperatively, or received pacemaker implantation were excluded. Patients were first divided into two groups:the intervention group (n=135, 53.6%) and the non-intervention group( n=117, 46.4%), further categorized by whether they were in sinus rhythm at discharge. The intervention group was then subdivided into the maze procedure group( n=54), and the PVI group (n=76). RESULTS: Within the maze procedure group, significant differences were observed between the sinus rhythm and non-sinus rhythm groups in terms of age, preoperative Af duration, and aortic valve intervention status. In the PVI group, patients with persistent Af, longer preoperative Af duration, and larger left atrium diameter( LAD) were less likely to return to sinus rhythm. Smaller LAD was also a significant factor for returning to sinus rhythm in the non-intervention group. Multivariate analysis for all patients revealed that an LAD smaller than 50 mm was the strongest predictor for returning to sinus rhythm post operation( p<0.01). CONCLUSION: For patients with persistent Af, the maze procedure is favored over PVI as a surgical intervention. When LAD exceeds 50 mm, the likelihood of returning to sinus rhythm is diminished.

Two-stage repair for DeBakey type II acute aortic dissection and distal aortic arch aneurysm in a nonagenarian patient.

Although total arch replacement would be performed in a patient with acute type A aortic dissection and concomitant aortic aneurysm in the distal aortic arch, total arch replacement may be too invasive in elderly patients with significant morbidities. A 92-year-old female with acute type II DeBakey aortic dissection and concomitant distal aortic arch aneurysm was successfully treated with hemi-arch replacement followed by thoracic endovascular aortic repair. Hybrid two-stage repair of DeBakey type II aortic dissection complicated by distal arch aneurysm using thoracic endovascular aortic repair after hemi-arch replacement may be effective.

Left atrial appendage aneurysm resection following the onset of a cardiogenic stroke: a case report.

A left atrial appendage aneurysm (LAAA) is a rare congenital or acquired anomaly that often causes fatal complications. Although many reports recommend surgical resection for treatment, there is no clear definition of LAAA. Therefore, the diagnosis and treatment are ambiguous. A 73-year-old woman with cardiogenic stroke was admitted to our hospital because of a suspected LAAA as the source of the embolus. She was incidentally diagnosed with LAAA seven years ago, which was managed with continuous anticoagulation therapy, although atrial fibrillation was not observed. The patient underwent aneurysm resection, and the postoperative course was uneventful.As LAAA symptoms are nonspecific, careful observation is required when LAAA is suspected. The risks associated with surgery are generally low and the surgical outcome is good; however, even with appropriate medical therapy, fatal complications can occur. Therefore, surgical resection of the LAAA should be considered even in asymptomatic patients, considering the low surgical risk.

Hemi-root replacement with diagonal resection of the aortic root preserving the ostium of the left coronary artery and sacrificing the right coronary artery for an infected pseudoaneurysm: a case report.

Either the Bentall-De Bono operation or the valve-sparing aortic root replacement is commonly chosen for aortic root management. However, if the preoperative condition is poor, a simpler technique is preferred; therefore, we performed hemi-root replacement with diagonal resection of the aortic root preserving the left coronary sinus of Valsalva. Because reimplantation of the left coronary artery is not required, this technique may shorten operative time and reduce coronary malperfusion, a condition characterized by reduced transit flow time and reduced cardiac contractility.

Case of laparoscopic-assisted anorectoplasty performed with temporary umbilical loop colostomy for high anorectal malformation (rectovesical fistula): a three-stage minimally invasive surgery.

This is the first report of three-stage laparoscopic-assisted anorectoplasty (LAARP) with temporary umbilical loop colostomy aiming for minimally invasive surgery in a boy with high anorectal malformation. The procedure was performed safely and resulted in small inconspicuous wounds. LAARP with temporary umbilical loop colostomy was a sufficiently useful therapeutic approach to high anorectal malformation.