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  • ISSN: 2573-1297
    Volume 2, Issue 2
    Case Report
    Kim Chai Chua*, KokHooi Yap, Yi Chuan Tham, Sivathasan Cumaraswamy, and TeingEe Tan
    Ventricular assist devices (VADs) have revolutionized treatment of advanced heart failure. VAD recipients benefit from improved functional status, better quality of life and good survival result. The advancement of post-VADs implant management, improved durability of devices and scarcity of heart donor have made VAD an attractive alternative to heart transplant, with an increasing trend of it being used as destination therapy rather than bridge therapy. The increasing demand for VAD therapy and complexity of patients called for alternative VAD implantation approaches to be addressed. We report a case of HeartWare VAD implantation via left thoracotomy with outflow graft anastomosis to the descending aorta in a patient with previous sternotomy from coronary artery bypass.
    Beatriz Moreno, Jose A. Buendia, Alejandro Cortes, Laura Puerto, Esperanza Carabias, María Jose Torres, Juan E. Alcala, and Luis F. Lopez Almodovar*
    Background: Superior vena cava syndrome is uncommon after cardiac surgery, because the formation of thrombus after cardiopulmonary bypass rarely occurs.
    Case presentation: Herein, we present a case of a patient with dynamic severe mitral regurgitation after aortic valve replacement. Whereas the treatment of this disorder was a challenge, the real complication, an early-onset and massive thrombosis of the superior vena cava, was hidden and misdiagnosed.
    Conclusion: Although superior vena cava syndrome after cardiac surgery has been reported previously, a large thrombus as the one described here is unusual. We have to keep in mind this complication in the presence of central vein catheter when we do no achieve our goal despite correct postoperative management.
    Research Article
    Eva Kottenberg*, Ulrich Frey, Peter Brendt, Lars Bergmann, Torsten Heine, Peter Lütkes, Michael Forsting, and Jürgen Peters
    Background: Near-infrared spectroscopy (NIRS) for brain monitoring has an uncertain value. We prospectively assessed the association of decreased NIRS tissue oxygenation index (TOI) with cerebral events in adults undergoing aortic arch repair with hypothermic circulatory arrest and bilateral antegrade selective cerebral perfusion.
    Methods: 76 consecutive patients (mostly aortic arch dissections/aneurysms) were studied. Desaturation was defined as unilateral or bilateral TOI decrease to <50% or to <80% of the individual patients’ baseline. No intervention was based on TOI data and the end-point was postoperative cerebral events shown by imaging.
    Results: Baseline TOI on left/right foreheads averaged 70.4% ± 10.8 (SD) and 67.9% ± 9.1, and did not change significantly thereafter. Twenty-six of 76 patients (34%) showed a TOI decrease to <50% and 55 (72%) a decrease to <80% from baseline. Cerebral complications occurred in 26/76 patients (34%), i.e., regional brain infarction (n=22) or edema (n=4). Twenty-six of 76 (34%) patients, 11 (42%) with and 15 (58%) without decreased TOI, had cerebral events but neither absolute TOI nor its decrease from baseline was predictive (p=0.206). Conversely, in patients with events, the incidence of decreased TOI was not different (11 vs. 15 of 26; 42% vs. 58%; p=0.206), whereas duration of hypothermic circulatory arrest (59min ± 34 vs. 43 ± 33, p=0.049) and bilateral antegrade selective cerebral perfusion (66min ± 27 vs. 50 ± 26, p=0.013), hospital-stay (p=0.001), and mortality (p=0.014) were different.
    Conclusions: Thus, while duration of hypothermic circulatory arrest with bilateral antegrade selective cerebral perfusion was predictive of postoperative cerebral events, the absolute or relative decrease in NIRS TOI was not.
    Short Communication
    Fourie N* and Banieghbal B
    Trans-pleural thoracoscopic repair of esophageal atresia was first performed in 1999. Esophageal leak rates are twice higher when compared to the open approach. Two-dimensional view and difficulty in suturing within the small neonatal chest cavity as well as the loss of tactile sensation may explain this higher leak rate. We propose that a sustained negative pleural pressure by trans-pleural approach may contribute to this leak rate. Over a 3-year period, 11 neonates undergoing patent ductus arteriosus ligation via extra- or trans-pleural approach were selected. After ligation, an intercostal drain was placed and a non-invasive manometer was connected to it. Continuous pressure measurement was carried out for 24 hours. In cases with extra-pleural approach; an initial negative pressure rapidly reached zero whereas in trans-pleural cases, pressures remained negative over 24 hours. It is therefore possible that increased esophageal leak may be as the result of sustained negative trans-pleural pressures.
    Editorial
    Federico Benetti*
    Despite Alexis Carrel early description of experimental CABG [1], surgeons were unable to translate these techniques successfully to humans due to a lack of technology and tools to operate on the unsupported beating heart. In 1952, Demikhov described the use of the LITA to directly graft the LAD in dogs, with graft patency confirmed for up to 2-years [2] Similar early success with the use of the ITA was reported by Canadian surgeon Gordon Murray [3]
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