Search

A 69-year-old man underwent minimal incision mitral valve repair for severe symptomatic mitral regurgitation. The echocardiography showed that he had normal left ventricular function with a moderately to severely dilated left atrium, a mildly dilated right atrium, and a large patent foramen ovale. The multistage venous cannulation was very challenging because we could not negotiate the guide wire from the inferior vena cava via the right atrium into the superior vena cava. Despite several attempts, the guide wire would pass into the patent foramen ovale. Methods that we routinely attempt with difficult cannulations such as withdrawing and reinserting, twisting, and to-and-fro movements did not result in success. Eventually, we attempted a novel maneuver, the modified "Valsalva maneuver," that worked incredibly well.

Background: Surgical pulmonary embolectomy (SPE) has been around since the early days of cardiac surgery. But with the increase in thrombolytic and intervention options, indications of SPE have been limited. Literature suggests that risk stratification has been a key step in getting good results. We are analyzing serum lactate levels for risk stratification in massive and submassive pulmonary embolism (PE).Methods: This study is a retrospective analysis of 82 cases that underwent SPE between January 1997 and January 2020. Patients were divided into two groups stratified by venous serum lactate levels on the first admission (Group I: normolactatemia <2 mmol/L, Group II: hyperlactatemia, >2 mmol/L). Primary endpoints were all-cause in-hospital mortality and secondary endpoints were cardiopulmonary bypass time, extracorporeal membrane oxygenator (ECMO) insertion, low cardiac output, blood product use, and right ventricular functions in the follow-up.Results: Our study had an overall follow-up of 23 years with a median of 3.18 years. Overall, the in-hospital mortality rate was 8.54%. Group II had a higher mortality rate (P = .015) and morbidity incidences like cardiopulmonary bypass time (P = .008), ECMO insertion (P = .036), and open chest after surgery (P = .015). Although 5-year survival was better in group I a compared to group II (81%, 95% CI, 69%-93% vs 65%, 95% CI, 46%-84%), the log rank test showed no statistical survival difference among both groups on long-term follow-up.Conclusions: Long term survival after SPE is good and these results can further be improved by proper PE risk stratification. Alongside computed tomography and echocardiography, the importance of biomarkers like serum lactate can be explored in the PE management algorithm. [ABSTRACT FROM AUTHOR]

Objective: This study evaluated the results for minimally invasive mitral valve (MV) surgery in patients who had undergone previous cardiac operations through a sternotomy. Methods: From March 1, 1999 to January 2008, minimally invasive MV reoperations were performed in 181 consecutive patients (110 men) with a mean age of 64.5 ± 12 years. A right-sided lateral minithoracotomy with femoral cannulation for cardiopulmonary bypass (CPB) was used. The principal indication was symptomatic severe mitral regurgitation (mean grade, 3.0 ± 0.8). Previous procedures were isolated coronary bypass grafting (CABG) in 76 (42%), isolated valve operation, 55 (30%); combined CABG and valve, 16 (9%); and other cardiac operations, 34 (19%). MV replacement was previously performed in 19 patients and MV repair in 31. Mean preoperative left ventricular ejection fraction was 0.54 ± 0.16. Results: MV repair, including repeat repair, was performed in 109 patients (60%) and MV replacement in 72 (40%). Operations were performed during ventricular fibrillation in 140 (77%), and a transthoracic aortic cross-clamp was used in 31 (17%). Ten patients (6%) underwent beating heart operations with CPB support. Mean total operating time was 176 ± 50 min. Mean CPB time was 135 ± 40 min. Thirty-day mortality was 6.6%. Early echocardiographic follow-up revealed excellent valve function in most patients. Conclusion: A minimally invasive approach is a useful alternative for patients requiring a MV procedure after a previous cardiac operation, particularly in patients with patent coronary bypass grafts or previous aortic valve replacement. Very good perioperative results can be achieved with this method. [Copyright &y& Elsevier]

Peripheral cannulation for cardiopulmonary bypass is increasingly used for minimally invasive and re-operative cardiac surgery. Transoesophageal echo (TOE) is used routinely to guide placement of the peripheral venous cannula in the right atrium/superior vena cava (SVC). We here present a case where despite use of TOE, placement of the venous cannula led to perforation of the right ventricular apex. We describe the surgical management of the problem and highlight strategies to avoid this complication. [ABSTRACT FROM AUTHOR]