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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]

Objectives: We would like to present our experience in repairing all types of atrial septal defect at Lampang Regional Hospital. In this study we also report the results of conventional and on-pump beating heart technique. Methods: From January 2010 to April 2015, 124 patients underwent atrial septal defect closure. There were 91 females and 33 males, with mean age 36.2 (range, 3 months-75 years). Results: The operation was performed with conventional technique in 45 patients compared to beating heart in 79 patients. The mean cardiopulmonary bypass time was 41.15 minutes in patients with conventional closure technique without tricuspid valve repair and 32.55 minutes in patients with beating heart closure technique without tricuspid valve repair. There was no death, no stroke and no residual shunt in all patients. The mean ICU stay was less than 24 hours in all patients. Conclusion: Repair of atrial septal defect at Lampang Regional Hospital is safe with no stroke or death. Repair of atrial septal defect secundum type with beating heart under cardiopulmonary bypass technique is an alternative technique that is also safe and can avoid ischemic-reperfusion injury. [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.)

Background: Atrial fibrillation (AF) is a common complication after cardiac surgery and impacts length of hospital stay, greater utilization of health care resources, and increases morbidity and mortality. Magnesium sulfate (MgSO4 ) has been well documented in its effect of AF reduction after cardiac surgery especially in coronary artery bypass grafting (CABG) but the dosages are still not settled., Material and Method: Eighty-eight elective CABG cases were randomized to receive a high dose (10 gm) or low dose (5 gm) MgSO4 and were blinded into bottle 1 (n = 46) and bottle 2 (n = 42). Patients were closely observed with continuous ECG monitoring in the first 24 hours then observed for clinical symptoms until discharge., Results: The demographic data were comparable except for a higher body weight in the high dose group (60.21±11.32 kg vs. 65.85±12.2 kg, p = 0.03) and higher incidence of diabetes in high dose group (52.4% vs. 28.3%, p = 0.02). Intraoperative data were similar. No complications were related to MgSO4 except one patient in the high dose group that experienced flushing and abdominal discomfort during administration. Immediate postoperative serum magnesium was higher in the high dose group but rapidly returned to similar level one day postoperatively. AF occurred in nine patients (10.23%), four in the low dose and five in the high dose group and there was no statistical significance (p = 0.62)., Conclusion: Current data suggested the safety and effectiveness of MgSO4 for the reduction of the incidence of AF during postoperative CABG surgery. However, there was no statistical difference between the dosages of MgSO4 supplement. The 5-gm-MgSO4 supplement was effective in AF prevention and could avoid the adverse effect from high dose MgSO4 infusion.

Objective: The epidemiologic data of catheter related blood stream infections (CRBSI) is different in each type of Intensive Care Unit (ICU). The objectives were to identify microbiological patterns, risk factors and mortality analysis in the surgical intensive care unit (SICU)., Material and Method: All CRBSI cases were reviewed in a 60-months period from the 1st ofJanuary, 2005 through the 31st of December, 2009. Two or three control patients, who had been catheterized within three days and were free of CRBSI, were randomly selected from the ICU admissions registration book as the control group; demographic data, mortality, organisms found and antibiotic sensitivity were recorded and analyzed., Results: In the 5-years period, 44 patients were diagnosed with a CRBSI and 129 patients who were without a CRBSI were selected. The total infection rate was 1.31 per 1,000 catheter-days. Nine patients who contracted a CRBSI (20.4%) expired. A primary diagnosis of gastrointestinal problems had shown the greatest risk for developing a CRBSI (69.7%). In proportions of gram negative bacteria:gram positive bacteria:fungus, this was measured at 43:36:21 respectively. Staphylococcus aureus was the most common gram positive bacteria found. Klebsiella pneumoniae, Enterobacter cloacae and Pseudomonas aeruginosa were the three most common gram negative bacteria found. The chance of developing a CRBSI was significantly increased after 10 days of catheterization. The mortality probability of gram negative bacterial infections and fungal infections increased over time. This was in contrast to gram positive bacterial infections, which decreased over time despite having shown the highest possibility of death earlier in catheter days. As for multivariable analyses, catheterization of patients in the general wards was the sole independent risk factor of CRBSI occurrences (OR = 8.67, p < 0.01) and the males (OR = 7.20, p = 0.03) have shown the highest risk factors for mortality., Conclusion: The occurrence of gram-negative bacteria and gram-positive bacteria related CRBSI was similar but the probability patterns of increasing the catheter days relating to CRBSI occurrence and mortality rates were different. Catheterization in the general wards was the only independent risk factor found for contracting a CRBSI in our institute. Males had the highest risk for mortality.