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Minimally invasive cardiac surgery off-pump coronary artery bypass (MICSOPCAB) has become increasingly prevalent, with devices like the heart positioner aiding in surgical precision. However, rare complications such as epicardial hematoma can occur. Here, we present a case of a 75-year-old man undergoing MICSOPCAB who developed an epicardial hematoma due to the heart positioner. The hematoma was successfully repaired intraoperatively with direct suturing and large felts. Postoperative recovery was uneventful, highlighting the importance of vigilant monitoring and prompt management of such complications. This case underscores the need for careful attention during the use of cardiac positioners to minimize adverse events and ensure favorable patient outcomes. [ABSTRACT FROM AUTHOR]

Objective: The advantage of the frozen elephant trunk technique (FET) is treating the aortic pathology extending from the aortic arch to the descending aorta in a one-stage operation. This study aimed to determine the early and long-term outcomes of total arch replacement with the frozen elephant trunk technique compared to conventional total arch replacement (cTAR). Materials and Methods: This study was a single-center, retrospective cohort study. Patients who underwent aortic arch replacement between January 2009 and December 2020 were enrolled and divided into two groups. 32 patients underwent the FET and 47 patients underwent cTAR. Outcomes and survival analysis were compared. Results: The 5-year survival for FET and cTAR were 87.27% and 82.55% and the aortic-related mortality was not significantly different (HR 0.97, 95%CI 0.22-0.43). Aortic re-intervention was significantly lower in the FET group accounting for 3.57%, while there was 39.1% in the cTAR group. FET significantly reduced aortic re-intervention compared with cTAR (HR 0.09, 95%CI 0.01-0.81). There were no differences in the incidence of stroke between the two groups. However, FET patients had significantly increased risks of paraplegia by 21% when compared to cTAR (Risk difference +0.21, 95%CI 0.02-0.40). Conclusions: The FET technique had comparable early outcomes in terms of mortality, renal function, postoperative bleeding, and recurrent laryngeal nerve injury. Even though FET had a significant risk of postoperative paraplegia, FET reduced the aortic re-intervention rate without increasing aortic-related death. [ABSTRACT FROM AUTHOR]

Second-time coronary artery bypass grafting is sometimes technically challenging due to severe adhesion of the heart, difficulty of identifying target coronary arteries, advanced sclerosis of the ascending aorta and limited availability of graft vessels. Here we report a patient, in whom a coronary-to-coronary bypass grafting from the native right coronary artery to the left anterior descending artery using a free right internal mammary artery was used as a graft conduit. [ABSTRACT FROM AUTHOR]

A 57-year-old male presented with dyspnea and an enlarged cardiac silhouette on a chest X-ray. Further evaluation with contrast-enhanced computed tomography revealed a giant heterogeneous mediastinal mass, ~8.9 × 7.3 × 12.2 cm, with peripheral calcifications. Surgical resection was performed via a left thoracotomy approach using the left fifth intercostal space. Cardiopulmonary bypass was established through the femoral vessels for safer and more controlled resection. The tumor, contiguous with the left atrium, was successfully excised using two Endo GIA staplers. Pathological examination confirmed the diagnosis of schwannoma. This case demonstrates that the left thoracotomy approach with cardiopulmonary bypass and the use of Endo GIA staplers is a feasible and effective option for resecting large, well-defined cardiac schwannomas., Competing Interests: None declared., (Published by Oxford University Press and JSCR Publishing Ltd. © The Author(s) 2024.)

Introduction: This study aims to clarify the good inflow site for saphenous vein grafts (SVG) in minimally invasive off-pump coronary artery bypass grafting (mini-CABG), between the ascending aorta, the internal thoracic arteries (ITAs) and the left axillary artery (LAA)., Methods: This retrospective study included 126 patients who underwent Mini-CABG at our center between January 2014 and July 2023. Patients were divided into three groups according to the SVG inflow site for patency comparison: Aorta group ( n  = 56), LAA group ( n  = 23), and ITA group ( n  = 47)., Results: There were 84 males, with mean age of 65.9 ± 7.0 years. There were no significant differences in preoperative characteristics between groups. Mean operation times were 254.6 ± 72.2, 213.7 ± 57.6, and 253.0 ± 81.2 min, and the average numbers of distal anastomoses were 2.9 ± 0.9, 2.4 ± 0.7 and 2.9 ± 1.1 in the Aorta, ITA and LAA groups respectively. Days in intensive care, hospital stay, and major complications did not differ between the groups. Early patency of SVG did not significantly differ among groups: 93.0% in the Aorta group, 98.0% in the ITA group, and 100% in the LAA group. Mean follow-up period was 136.7 ± 295.7 days, and follow-up coronary CTA revealed 18 SVG occlusions (Aorta group n  = 8, ITA group n  = 5, LAA group n  = 5). The Kaplan-Meier curve for SVG patency rates did not show any significant differences among the three groups., Conclusion: The ascending aorta, the ITAs, and the LAA serve as reliable inflow sites with similar results in mini-CABG., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2024 Ushioda, Hirofuji, Yoongtong, Sakboon, Cheewinmethasiri, Lokeskrawee, Patumanond, Lawanaskol, Kamiya and Arayawudhikul.)

Introduction: At our institution, we perform off-pump coronary artery bypass (OPCAB) as a standard procedure. Moreover, patients with favorable coronary anatomy and condition are selected for minimally invasive cardiac surgery (MICS)-OPCAB. We retrospectively compared early outcomes, focusing on safety, between MICS-OPCAB and conventional off-pump techniques for multivessel coronary artery bypass grafting (CABG)., Methods: From August 2017 to September 2022, 1,220 patients underwent multivessel coronary artery grafting at our institution. They were divided into the MICS-OPCAB group (MICS group = 163 patients) and the conventional OPCAB group (MS group = 1057 patients). Propensity score matching (1 : 1 ratio) was applied to the MICS-OPCAB and MS groups (149 patients per group) based on 23 preoperative clinical characteristics., Results: After matching, there were no significant differences in preoperative characteristics between the groups. The MICS group had a lower total graft number (2.3 ± 0.6 vs. 2.9 ± 0.8, p  < 0.001) and fewer distal anastomoses (2.7 ± 0.8 vs. 3.2 ± 0.9, p  < 0.001). There were no significant differences in hospital stay, intensive care unit stay, postoperative complications, and 30-day mortality. The MICS group had less drain output (MICS 350 ml [250-500], MS 450 ml [300-550]; p  = 0.013). Kaplan-Meier analysis revealed no significant differences in postoperative MACCE (major adverse cardiac or cerebrovascular events)-free and survival rates between the groups (MACCE-free rate p  = 0.945, survival rate p  = 0.374)., Conclusion: With proper patient selection, MICS-OPCAB can provide good short to mid-term results, similar to those of conventional OPCAB., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2024 Ushioda, Hirofuji, Yoongtong, Sakboon, Cheewinmethasiri, Lokeskrawee, Patumanond, Lawanaskol, Kamiya and Arayawudhikul.)

Introduction: The minimally invasive cardiac surgery off-pump coronary artery bypass (MICSOPCAB) is technically difficult; therefore, previous studies have indicated that MICSOPCAB should be contraindicated in patients with impaired left ventricular (LV) function. In this study, we investigated the feasibility of MICSOPCAB in patients with impaired LV function., Methods: The 226 patients underwent MICSOPCAB between August 2017 and September 2022. Our study defined impaired LV function as ejection fraction (EF) in echocardiography 40% or less. The patients were divided into Low EF group ( n  = 39) and Normal EF group ( n  = 187)., Results: The Low EF group was in a more critical preoperative condition than Normal EF group (41.0% in the Low EF group vs. 14.4% in the Normal EF group; p  < 0.001). For preoperative transthoracic echocardiography, LV end-diastolic diameter (5.5 ± 0.9 cm in the Low EF group vs. 5.0 ± 0.8 cm in the Normal EF group; p  < 0.001) and LV end-systolic diameter (4.4 ± 1.0 cm in the Low EF group vs. 3.4 ± 1.0 cm in the Normal EF group; p  < 0.001) were significantly larger in the Low EF group. No differences were found in the operative time (180 [160-240] min in the Low EF group vs. 205 [165-253] min in the Normal EF group; p  = 0.231) and the median number of distal anastomoses (2 [1-2] in the Low EF group vs. 2 [1-3] in the Normal EF group; p  = 0.073). Intensive care unit stay was longer in the Low EF group than in the Normal EF group (2 [1-2] in the Low EF group vs. 1 [1-2] in the Normal EF group; p  = 0.010). Perioperative transfusion was more common in the Low EF group than in the Normal EF group (69.7% vs. 49.2%; p  = 0.023). There were no differences in major complications, hospital stay, and 30-day mortality. The Kaplan-Meier curve showed no significant difference in postoperative major adverse cardiac or cerebrovascular events rates between the two groups ( p  = 0.185)., Conclusion: In this study, MICSOPCAB can be performed in patients with low EF having short- and mid-term outcomes similar to patients with normal EF. Therefore, low EF should not be contraindicated in MICSOPCAB., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2024 Ushioda, Hirofuji, Yoongtong, Sakboon, Cheewinmethasiri, Kamiya and Arayawudhikul.)

Minimally invasive mitral valve surgery (MIMVS) is widespread and has become a standard procedure in cardiac surgery [Chitwood 1997; Carpentier 1996]. Therefore, MIMVS is a common procedure for patients with degenerative disease [Raanani 2010; Iribarne 2010] as well. However, the safety of MIMVS in patients with rheumatic heart disease (RHD) has not thoroughly been investigated, due to the low prevalence of RHD in developed countries, where MIMVS is standardized [Miceli 2015]. Here, we investigated the safety of MIMVS for patients with RHD at Lampang Hospital in Thailand.