BackgroundProper monitoring of cerebral perfusion during carotid artery surgery is crucial for determining if a shunt is needed. We compared the safety and reliability of near-infrared spectroscopy (NIRS) with transcranial Doppler (TCD) for cerebral monitoring.MethodsThis single-center, retrospective review was conducted on patients who underwent carotid endarterectomy (CEA) using selective shunt-based TCD or NIRS at Daegu Catholic University Medical Center from November 2009 to June 2016. Postoperative complications were the primary outcome, and the distribution of risk factors between the 2 groups was compared.ResultsThe medical records of 74 patients (45 TCD, 29 NIRS) were reviewed. The demographic characteristics were similar between the 2 groups. One TCD patient died within the 30-day postoperative period. Postoperative stroke (n=4, p=0.15) and neurologic complications (n=10, p=0.005) were only reported in the TCD group. Shunt usage was 44.4% and 10.3% in the TCD and NIRS groups, respectively (p=0.002).ConclusionNIRS-based selective shunting during CEA seems to be safe and reliable for monitoring cerebral perfusion in terms of postoperative stroke and neurologic symptoms. It also reduces unnecessary shunt usage.

Highlights 19 patients (24%) were treated with ECMO among 80 mechanical ventilation-supported patients. Weaning and mortality rate of ECMO was 42% (8/19) and 58% (10/19), respectively. Despite the known low case-fatality rate of COVID-19, mortality rate of ECMO-treated patients was substantial.

BackgroundModerate and severe hypothermia with cardiopulmonary bypass during aortic surgery can cause some complications such as endothelial cell dysfunction or coagulation disorders. This study found out the difference of vascular reactivity by phenylephrine in moderate and severe hypothermia.MethodsPreserved aortic endothelium by excised rat thoracic aorta was sectioned, and then down the temperature rapidly to 25℃ by 15 minutes at 38℃ and then the vascular tension was measured. The vascular tension was also measured in rewarming at 25℃ for temperatures up to 38℃. To investigate the mechanism of the changes in vascular tension on hypothermia, NG-nitro-L-arginine methyl esther (L-NAME) and indomethacin administered 30 minutes before the phenylephrine administration. And to find out the hypothermic effect can persist after rewarming, endothelium intact vessel and endothelium denuded vessel exposed to hypothermia. The bradykinin dose-response curve was obtained for ascertainment whether endothelium-dependent hyperpolarization factor involves decreasing the phenylnephrine vascular reactivity on hypothermia.ResultsFifteen minutes of the moderate hypothermia blocked the maximum contractile response of phenylephrine about 95%. The vasorelaxation induced by hypothermia was significantly reduced with L-NAME and indomethacin administration together. There was a significant decreasing in phenylephrine susceptibility and maximum contractility after 2 hours rewarming from moderate and severe hypothermia in the endothelium intact vessel compared with contrast group.ConclusionThe vasoplegic syndrome after cardiac surgery might be caused by hypothermia when considering the vascular reactivity to phenylephrine was decreased in the endothelium-dependent mechanism.

Aortoesophageal fistula (AEF) is a rare and potentially fatal disease that causes massive gastrointestinal bleeding. Therefore, early diagnosis and treatment are essential to prevent mortality. Controlling the massive bleeding is the most important aspect of treating AEF. The traditional surgical treatment was emergent thoracotomy, but intraoperative or perioperative mortality was high. We report a case of a patient presenting with hematemesis who was successfully treated by a staged treatment, in which bridging thoracic endovascular aortic repair was followed by delayed surgical repair of the esophagus and aorta.

BackgroundConventional open repair is a suboptimal therapy for blunt traumatic aortic injury (BTAI) due to the high postoperative mortality and morbidity rates. Recent advances in the thoracic endovascular repair technique may improve outcomes so that it becomes an attractive therapeutic option.Materials and MethodsFrom August 2003 to March 2012, 21 patients (mean age, 45.81 years) with BTAI were admitted to our institution. Of these, 18 cases (open repair in 11 patients and endovascular repair in 7 patients) were retrospectively reviewed and the early perioperative results of the two groups were compared.ResultsAlthough not statistically significant, there was a trend toward the reduction of mortality in the endovascular repair group (18.2% vs. 0%). There were no cases of paraplegia or endoleak. Statistically significant reductions in heparin dosage, blood loss, and transfusion amounts during the operations and in procedure duration were observed.ConclusionCompared with open repair, endovascular repair can be performed with favorable mortality and morbidity rates. However, relatively younger patients who have acute aortic arch angulation and a small aortic diameter may be a therapeutic challenge. Improvements in graft design, delivery sheaths, and graft durability are the cornerstone of successful endovascular repair.

A five-month-old boy who had undergone previously transcatheter balloon atrioseptostomy at 3 days of age for complete transposition of the great arteries with ventricular septal defect and pulmonary stenosis underwent pulmonary root translocation with the Lecompte maneuver. This operation has the advantages of maintaining pulmonary valve function, preserving the capacity for growth, and avoiding problems inherent to the right ventricular to pulmonary artery conduit. This patient progressed well for 9 months postoperatively and we report this case of pulmonary root translocation with the Lecompte maneuver.

We researched on the factors affecting the duration of antibiotic use due to surgical site inflammation after complication-free classical total knee arthroplasty (TKA). Four hundred and eighty-nine cases who underwent primary TKA performed by 1 surgeon from January 2015 to December 2018 were enrolled. Including the day of operation, first-generation cephalosporin was injected intravenously for 3 days for antimicrobial prophylaxis. At the third postoperative day, we inspected the surgical wound for any signs of inflammation. If there were any signs of redness, pain, heatness, or swelling, which are the cardinal signs of superficial incisional surgical site infection defined by the Centers of Disease Control (CDC), additional antibiotics were injected until the symptoms of surgical site inflammation improved. We presumed that the duration of antibiotic use was affected by factors including gender, age, body mass index, whether operating on both legs or one leg, predisposing diabetes mellitus, preoperative glomerular filtration rate, preoperative serum albumin level, prior history of anticoagulant usage including anti-platelet agents, allogenic blood transfusion during admission, and total operative time. Average duration of intravenous antibiotic use in 489 cases was 5.73 ± 4.03 days. Pearson correlation analysis showed significant correlation ( P < .01) between operative time and duration of antibiotic use due to surgical site inflammation. In univariate analysis, total operative time and transfusion were factors affecting the duration of antibiotic use due to surgical site inflammation (<6 days or ≥6 days). Multivariate analysis of age, gender, body mass index, staged bilateral TKA, diabetes mellitus, preoperative glomerulus filtration rate, preoperative albumin level, prior history of anticoagulant usage, allogenic blood transfusion during admission, and total operative time revealed that longer operative time was related to higher likelihood of antibiotic use for >6 days during admission. When prophylactic antibiotics are prescribed, surgeons must note that signs of superficial incisional surgical site inflammation after classical complication free TKA may manifest more often in patients with longer operative time.

Innominate artery aneurysms are challenging for surgeons to treat because of the requirement for brain protection during surgery. In innominate artery aneurysms, the endovascular approach does not require cardiopulmonary bypass, but patients who can be treated using this approach are limited in number, and the long-term results of endovascular treatment are unclear. Here, we report our experience of successfully treating a patient with an innominate artery aneurysm using near-infrared spectroscopy without cardiopulmonary bypass support or hypothermic circulatory arrest.