BackgroundThis study aimed to compare preliminary data on the outcomes of sutureless aortic valve replacement (SU-AVR) with those of aortic valve replacement (AVR).MethodsWe conducted a retrospective study of SU-AVR in moderate- to high-risk patients from 2013 to 2016. Matching was performed at a 1:1 ratio using the Society of Thoracic Surgeons predicted risk of mortality score with sex and age. The primary outcome was 30-day mortality. The secondary outcomes were operative outcomes and complications.ResultsA total of 277 patients were studied. Ten patients (50% males; median age, 81.5 years) underwent SU-AVR. Postoperative echocardiography showed impressive outcomes in the SU-AVR group. The 30-day mortality was 10% in both groups. In our study, the patients in the SU-AVR group developed postoperative thrombocytopenia. Platelet counts decreased from 225×103/μL preoperatively to 94.5, 54.5, and 50.1×103/μL on postoperative days 1, 2, and 3, respectively, showing significant differences compared with the AVR group (p=0.04, p=0.16, and p=0.20, respectively). The median amount of platelet transfusion was higher in the AVR group (12.5 vs. 0 units, p=0.052).ConclusionThere was no difference in the 30-day mortality of moderate- to high-risk patients depending on whether they underwent SU-AVR or AVR. Although SU-AVR is associated with favorable cardiopulmonary bypass and cross-clamp times, it may be associated with postoperative thrombocytopenia.
A 69-year-old woman developed dyspnoea 1 day after percutaneous pericardiocentesis for idiopathic pericardial effusion. On the exam, she had a pulsus paradoxus of 12 mm Hg and an elevated jugular venous pulse. The chest radiograph showed air separating the pericardium from the heart, indicating pneumopericardium (Panel A, black arrows). An echocardiogram showed moderate amount of pericardial effusion with a number of pericardial air microbubbles (Panel B,C, asterisks, video clips 1 and 2). Echocardiographic signs of tamponade, including early right ventricular diastolic collapse and significant respiratory variation of tricuspid (Panel D) and mitral (Panel E) inflows and superior vena caval flow (Panel F), were clearly evident. Emergent surgical pericardial drainage and biopsy were then performed, yielding in a resolution of dyspnoea and a significant increase in blood pressure. The pericardial fluid analysis, histopathology and culture were negative for specific pericardial diseases and microorganism.Pneumohydropericardium after percutaneous pericardiocentesis is a rare complication; however, this may be fatal due to the rapid accumulation of air and fluid. 1 2 A meticulous procedural technique that does not allow air to enter the drainage catheter and a close postprocedural surveillance are key to preventing this complication.
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