Complicated Massive Left Ventricular Thrombus and Surgical Treatment.

BACKGROUND Left ventricular thrombus formation is a serious complication of cardiac diseases and may result in acute embolic events. Early diagnosis and prompt treatment are crucial steps in preventing complications. There is a lack of consensus when it comes to therapy recommendations such as treatment with anticoagulation, thrombolysis, or surgical thrombectomy. CASE REPORT A 74-year-old woman presented with acute peripheral ischemia in the left and right lower limbs. After running a diagnostic workup, we found a history of fatigue and dyspnea in the preceding 2 weeks; and an echocardiographic examination revealed a large floating mass in the left ventricle with a severely reduced LV ejection fraction of 10-15%. Coronary heart disease was diagnosed with stenosis of the circumflex artery and posterior branch of the right coronary artery, but not necessitating acute treatment. The decision to operate on our patient was based on the acute situation and mobile form of the thrombi as to prevent further thromboembolic complications, and the surgical procedure was performed via a median sternotomy using a left ventricular apical approach due to the size and deep embedment in the ventricular trabeculae. CONCLUSIONS To date there is no standardized therapy in the guidelines for treatment of LV thrombi. Surgical thrombectomy can be performed in patients with mobile and protruding thrombi. In such cases surgery should be performed immediately due to the high risk of systemic embolism.

Peripheral vs. Central Cannulation in Cardiac Reoperations: Technical Considerations and Outcomes.

OBJECTIVE: To compare peripheral and central cannulation techniques in cardiac reoperation. METHODS: This retrospective study included 258 patients undergoing cardiac reoperation between January 2013 and July 2018. Patients were divided into two groups according to the cannulation type. The first group included 145 (56.2%) patients operated with standard central cannulation through aorta and right atrium or bicaval cannulation. In this group, cardiopulmonary bypass was instituted after sternotomy. The second group consisted of 113 (43.8%) patients operated with peripheral cannulation through femoral artery, vein, and internal jugular vein. In this group, cardiopulmonary bypass was started before sternotomy and after systemic heparinisation. The two groups' operative complications and postoperative outcomes were compared. RESULTS: Procedure-related injury was higher in the central cannulation group than in the peripheral cannulation group (8.3% vs. 1.8%, respectively, P=0.038). Cardiopulmonary bypass time was shorter in the central cannulation group (P=0.008) and total operation time was similar between the groups (P=0.115). Postoperative red blood cell requirement was higher with central cannulation (P=0.004). Operative mortality (2.8% vs. 0, P=0.186), hospital mortality (4.3% vs. 2.7%, P=0.523), and one-year survival rate (90.3% vs. 94.7%, P=0.202) were similar between the groups. CONCLUSION: Peripheral cannulation reduces cardiac injury and blood transfusion in cardiac reoperation. The cannulation type does not affect postoperative complication, mortality, and one-year survival.

Peripheral vs. central cannulation in cardiac reoperations: technical considerations and outcomes

Abstract Objective: To compare peripheral and central cannulation techniques in cardiac reoperation. Methods: This retrospective study included 258 patients undergoing cardiac reoperation between January 2013 and July 2018. Patients were divided into two groups according to the cannulation type. The first group included 145 (56.2%) patients operated with standard central cannulation through aorta and right atrium or bicaval cannulation. In this group, cardiopulmonary bypass was instituted after sternotomy. The second group consisted of 113 (43.8%) patients operated with peripheral cannulation through femoral artery, vein, and internal jugular vein. In this group, cardiopulmonary bypass was started before sternotomy and after systemic heparinisation. The two groups' operative complications and postoperative outcomes were compared. Results: Procedure-related injury was higher in the central cannulation group than in the peripheral cannulation group (8.3% vs. 1.8%, respectively, P=0.038). Cardiopulmonary bypass time was shorter in the central cannulation group (P=0.008) and total operation time was similar between the groups (P=0.115). Postoperative red blood cell requirement was higher with central cannulation (P=0.004). Operative mortality (2.8% vs. 0, P=0.186), hospital mortality (4.3% vs. 2.7%, P=0.523), and one-year survival rate (90.3% vs. 94.7%, P=0.202) were similar between the groups. Conclusion: Peripheral cannulation reduces cardiac injury and blood transfusion in cardiac reoperation. The cannulation type does not affect postoperative complication, mortality, and one-year survival.