Veno-arterial extracorporeal membrane oxygenation for post-infarction ventricular septal defect in a low-volume center.

Managing patients with post-ischaemic ventricular septal defects (VSD) and postcardiotomy cardiogenic shock can be extremely challenging in a low-volume cardiac surgery unit. We present a case of a 68-year-old patient who received veno-arterial extracorporeal membrane oxygenation support due to cardiogenic shock after VSD repair. The patient was successfully weaned off support after 86 h. In the postoperative period, mediastinitis occurred, and negative pressure wound therapy was instituted.

Surgeon-Guided Robotic Arm Facilitates LIMA Takedown in MIDCAB Surgery.

Left internal mammary artery (LIMA) to left anterior descending (LAD) coronary artery bypass has been scientifically proven to have the best patency and long-term results in myocardial revascularization. The latest guidelines suggest minimally invasive LIMA to LAD is the optimal therapy for isolated proximal LAD lesions. The start of a minimally invasive direct coronary artery bypass (MIDCAB) program can be quite challenging as robotic surgery demands high starting costs, while normal thoracoscopic techniques have a longer surgeon learning curve. In this article, we describe to the best of our knowledge the first use of surgeon-guided wristed instruments in LIMA harvesting for MIDCAB surgery. It allows for a facilitated LIMA harvest like in robotic surgery with the comfort of a surgeon constantly standing by the patient, allowing for a faster response time in case of an emergency or the need for instrument exchange. These features result in shorter operating times, lower costs compared with robotic surgery, and faster adoption of this technique for centers just starting MIDCAB surgery.

THERMOACTIVE NITINOL CLIPS AS PRIMARY AND SECONDARY STERNAL CLOSURE AFTER CARDIAC SURGERY - FIRST EXPERIENCE IN SLOVENIA.

Although there has been a trend towards minimally invasive and sternum-sparing procedures, median sternotomy is still a standard surgical approach in cardiac surgery. Many techniques and innovations for closure of sternal osteotomy have been developed with contradictory results. In this report, we present our first experience with the nitinol-made sternal closure system in the primary, as well as secondary closure of sternal osteotomy. A small series of 20 patients had their sternotomy closed with Flexigrip clips. In one case, the Flexigrip clips were used in secondary wound closure in a patient with deep sternal wound infection after full sternotomy and coronary bypass surgery. After 6-month follow-up, all patients were doing well with their sternums clinically stable and the sternotomy wounds completely healed. In conclusion, Flexigrip clips offered a stable alternative to steel wires in primary, as well as secondary sternal closure. Moreover, in secondary sternal closure, the thermoactive clips offered safety advantages over the standard wire cerclage technique because the need for dissection of the substernal adhesions could be avoided.

Left ventricular pseudoaneurysm following atrioventricular groove rupture after mitral valve replacement.

Left ventricular pseudoaneurysm is a partial cardiac rupture, contained by the surrounding pericardium that maintains communication with the left ventricular lumen. Whereas most cases of left ventricular pseudoaneurysms are related to myocardial infarction (loss of myocardial integrity), only a handful are associated with valve surgery. We present a female patient, who was admitted for elective mitral valve replacement. After the implantation of the mechanical valve, we encountered a rupture of the atrioventricular groove. After 3 months, a left ventricular pseudoaneurysm was found and the patient was reoperated. The valve was explanted and the inspection of the annulus and previously implanted pericardial patch revealed a loosened stitch on the inferior (ventricular) side. The defect was reinforced with additional stitches and the valve was reimplanted. In conclusion, we report an unusual case with two serious complications after mitral valve replacement - atrioventricular groove rupture and left ventricular pseudoaneurysm.