RESUMO
BACKGROUND: COVID-19 has caused a global pandemic of unprecedented proportions. Elective cardiac surgery has been universally postponed with only urgent and emergency cardiac operations being performed. The National Health Service in the United Kingdom introduced national measures to conserve intensive care beds and significantly limit elective activity shortly after lockdown. CASE PRESENTATION: We report two cases of early post-operative mortality secondary to COVID-19 infection immediately prior to the implementation of these widespread measures. CONCLUSION: The role of cardiac surgery in the presence of COVID-19 is still very unpredictable and further studies on both short term and long term outcomes are warranted.
Assuntos
COVID-19/epidemiologia , Procedimentos Cirúrgicos Cardíacos/mortalidade , Emergências/epidemiologia , Pandemias , Idoso , Comorbidade , Procedimentos Cirúrgicos Eletivos/mortalidade , Humanos , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , SARS-CoV-2 , Medicina Estatal , Taxa de Sobrevida/tendências , Reino Unido/epidemiologiaRESUMO
OBJECTIVE: Composite aortic root replacement is a standard procedure for various aortic root pathologies. This systematic review was set to identify the postoperative outcomes for composite mechanical root replacement (mCRR) compared to composite biological root replacement (bCRR). METHODS: We systematically reviewed four major databases for all papers assessing outcomes in composite root replacement. Articles selected were chosen by two reviewers. Amongst our inclusion and exclusion criteria, all pediatric populations were excluded as were studies with a cohort less than 50 patients. RESULTS: We identified seven studies that conformed to our inclusion criteria and incorporated 2240 patients. In-hospital mortality was higher but non-significant in the mechanical group (6.1 vs 4.2% respectively). There was no significant difference demonstrated in the risk of in-hospital stroke, late stroke and re-operation in either groups. Additionally, there was no significant difference in: endocarditis, 1-year mortality, 5-year mortality, mean cardiopulmonary or aortic cross-clamp time. CONCLUSIONS: Composite mechanical root offers no superiority to composite biological root. There is a significant increase in the perioperative bleeding amongst composite mechanical root cohort. There is a need for further randomized control trail to assess the efficacy of either methods.
Assuntos
Aorta Torácica/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Prótese Vascular , Complicações Pós-Operatórias , Procedimentos Cirúrgicos Vasculares/métodos , Seguimentos , Humanos , Fatores de TempoRESUMO
Cardiovascular surgeons have long debated the safe duration of deep hypothermic circulatory arrest during thoracic aortic aneurysm surgery. The rationale for using adjunctive cerebral perfusion (or not) is to achieve the best technical aortic repair with the lowest risk of morbidity and death. In this literature review, we highlight the debates surrounding these issues, evaluate the disparate findings on deep hypothermic circulatory arrest durations and temperatures, and consider the usefulness of adjunctive perfusion.
Assuntos
Aneurisma da Aorta Torácica/cirurgia , Parada Circulatória Induzida por Hipotermia Profunda/métodos , Procedimentos Cirúrgicos Vasculares , HumanosRESUMO
We describe our technique for reconstructing the free right atrial wall and superior vena cava using CorMatrix (CorMatrix Alpharetta, GA, USA) extracellular matrix following resection of a large leiomyosarcoma.
Assuntos
Procedimentos Cirúrgicos Cardiovasculares/métodos , Matriz Extracelular/transplante , Neoplasias Cardíacas/secundário , Neoplasias Cardíacas/cirurgia , Leiomiossarcoma/secundário , Leiomiossarcoma/cirurgia , Procedimentos de Cirurgia Plástica/métodos , Neoplasias Uterinas/patologia , Veia Cava Superior/cirurgia , Animais , Bioprótese , Prótese Vascular , Feminino , Átrios do Coração/cirurgia , Humanos , Pessoa de Meia-Idade , Invasividade NeoplásicaRESUMO
Kikuchi-Fujimoto disease (KFD) is a benign, self-limiting subacute necrotizing lymphadenitis with unknown aetiology that has a predilection for young Far East Asian women. It presents with fever, fatigue and lymphadenomegaly and is often misdiagnosed. We report an unusual presentation in a South Asian woman with isolated mediastinal lymphadenopathy masquerading as tuberculosis. There is only one other reported case in the literature presenting with isolated mediastinal lymphadenopathy.
Assuntos
Linfadenite Histiocítica Necrosante/diagnóstico , Tuberculose dos Linfonodos/diagnóstico , Adulto , Diagnóstico Diferencial , Feminino , Linfadenite Histiocítica Necrosante/tratamento farmacológico , Humanos , Valor Preditivo dos Testes , Esteroides/uso terapêutico , Tomografia Computadorizada por Raios X , Tuberculose dos Linfonodos/tratamento farmacológicoRESUMO
Aortic valve reoperation after homograft root implantation is high risk and may be technically challenging. Dense calcification of the annulus may prevent suture placement and often necessitates impromptu high-risk redo root replacement. Although transcutaneous aortic valve implantation is an attractive option in such scenarios, in the context of endocarditis it is contraindicated. We describe a novel approach to aortic valve replacement in a patient with infective endocarditis of a heavily calcified homograft root, using a sutureless valve. This approach successfully avoided the need for redo root replacement with its attendant risks.
Assuntos
Valva Aórtica/cirurgia , Calcinose/cirurgia , Endocardite Bacteriana/cirurgia , Idoso , Valva Aórtica/transplante , Humanos , Masculino , Reoperação , Transplante HomólogoRESUMO
Most reports of coronary artery bypass grafting in adult patients with dextrocardia have focused on the surgeon's position with respect to the operating table. Herein, we describe the cases of 2 patients with dextrocardia who underwent surgery at our own institution, then discuss preoperative evaluation, surgical approaches, and patient outcomes that have been reported in the medical literature. Whereas most patients, including ours, have presented with classic situs inversus totalis and dextrocardia, a few patients have had other associated anomalies or atypical morphologic conditions. Careful imaging, and perhaps cardiac catheterization, is required. Particular attention should be paid to cannulation technique and conduits that can best be used within the altered orientation of the heart. Morbidity rates in these revascularized patients seem comparable with those in coronary artery bypass patients whose coronary anatomy is normal. Anatomic variants in dextrocardia are important from the surgical viewpoint due to the increasing population of patients with repaired congenital heart disease who reach adulthood, and in whom other cardiac defects and abnormalities of cardiac position are common.
Assuntos
Ponte de Artéria Coronária , Doença da Artéria Coronariana/cirurgia , Dextrocardia/complicações , Situs Inversus/complicações , Ponte Cardiopulmonar , Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/diagnóstico , Dextrocardia/diagnóstico , Parada Cardíaca Induzida , Humanos , Hipotermia Induzida , Masculino , Pessoa de Meia-Idade , Seleção de Pacientes , Situs Inversus/diagnóstico , Resultado do TratamentoRESUMO
The acute chest syndrome (ACS) of sickle cell disease (SCD) is a leading cause of death in SCD, with a high incidence following surgery, though only one case has been reported following cardiac surgery. We present a case of ACS in an adult undergoing aortic valve replacement (AVR) despite instituting established peri-operative optimization measures to prevent sickling. Early diagnosis of this condition in our patient as a distinct clinical entity facilitated appropriate, specific therapy and a good subsequent postoperative recovery. Greater recognition of this syndrome in the growing number of adult sickle cell patients presenting for cardiac surgery may help improve their outcome.