Background Thoracic endovascular aortic repair (TEVAR) is the standard-of-care for treating traumatic aortic injury (TAI). Few retrospective studies compared TEVAR to open repair in blunt traumatic aortic injury (BTAI). Our objectives were to compare the early outcomes of TEVAR for blunt traumatic descending aortic injury to open repair (OR) in polytraumatic patients involved in motor vehicle accidents (MVA). Results Between February 2005 and April 2017, 71 patients with TAI due to MVA presented to our institution. All patients with descending aortic injuries were considered for open repair (n = 41) or TEVAR (n = 30) if there was no contraindication. The primary outcome was mortality, and secondary outcomes were stroke, paraplegia, intensive care unit (ICU), and hospital stay. The mean age was 28.4 ± 10.1 years in the OR group and 33.3 ± 16.6 years in TEVAR-group (P = 0.13). The injury severity scores were 41 ± 10 in the OR group and 33 ± 17 in the TEVAR group (P = 0.03). Patients in the OR group underwent emergency repair with a mean time of 0.56 ± 0.18 days from arrival. The TEVAR group had a longer time interval between arrival and procedure (2.1 ± 1.7 days, P = 0.001). The OR group had more blood transfusion (24 (58.5%) vs. 8 (27.5%), P = 0.002), renal impairment (6 (14.6%) vs. 1 (5.50%), P = 0.23), and wound infection (21 (51.2%) vs. 3 (10%), P < 0.001). Three TEVAR patients had a perioperative stroke compared to two patients in the OR group (P = 0.64). There was no difference in the mean ICU (6 ± 8.9 vs. 5.3 ± 2.9 days; P = 0.1) or hospital stay (20.1 ± 12.3 vs. 20.1 ± 18.3, P = 0.62) between the two groups. There were four deaths in the OR group and none in the TEVAR group (P = 0.13). Conclusion The results of TEVAR were comparable with the open repair for traumatic aortic injury with good early postoperative outcomes. TEVAR repair could be associated with lower mortality, blood transfusion, and infective complications. However, the complexity of the injury and technical challenges were higher in the open group.
Background: Endoscopic harvest of the radial artery avoids long forearm incisions and has better cosmesis compared to the open technique. The objective of this study was to compare the short-term results and woundrelated complications of endoscopic radial artery harvest versus open technique. Results: From 2013 to 2017, 800 patients had coronary artery bypass grafting; 88 patients of them had radial artery harvesting (11%). Two groups were included in the study according to the surgeon preference, endoscopic radial harvest (group 1, n = 30; 3.75% of total CABG patients) and open harvest (group 2, n = 58; 7.25% of total CABG patients). Group 1 had more males (25 (83.33%) vs. 35 (60.34%); p = 0.028). There was no difference in the preoperative comorbidities between both groups. The duration of the harvest was significantly longer in group 1 (median 40 min ranges from 38 to 42 min vs. 49 min ranges from 47 to 52 min in groups 1 and 2, respectively; p < 0.001). The operative time was longer in group 1 (median 302.5 min ranges from 295 to 310 min vs. 277 min ranges from 273 to 280 min in groups 1 and 2, respectively; p < 0.001). The hospital stay in the endoscopic radial artery harvest group was significantly shorter than that of open technique (median 7 days ranges from 6 to 7 days vs. 7.5 days ranges from 7 to 9 days; p < 0.001). There was no significant difference in the postoperative complications between both groups. One case (3.3%) was transformed from the endoscopic to open technique due to uncontrolled bleeding. Endoscopic technique was associated with more patients presenting with hand numbness (6 cases; 20% versus 3 cases 5.2%) and radial nerve injury (2 cases; 6.6% versus none), while open technique showed more cases of local hematoma (8 cases; 13.8% versus 1 case; 3.3%) and wound infection (6 cases; 10.34% versus none); p > 0.05. Conclusion: Endoscopic radial artery harvest is associated with shorter harvest time and shorter hospital stay. Endoscopic radial artery harvest is a safe technique with good short-term outcomes. Longer follow-up is recommended.
Background: The CarboMedics Top-Hat aortic valve prosthesis was designed to be implanted in a supra-annular position. This study aimed to compare the hemodynamic performance of the Top-Hat aortic prostheses versus the standard CarboMedics aortic valve prostheses. Methods: The study included 98 patients who had aortic valve replacement and were divided into two groups. Group A included 60 patients who had standard aortic valve prostheses, and Group B included 38 patients who had the Top-Hat aortic prostheses. The study endpoints were hospital outcomes, the effective orifice area, and the pressure gradient during a one-year follow-up. Results: There was no significant difference in the baseline echocardiographic data and risk factors between the groups. The patients who had Top-Hat aortic prosthesis were younger, with a mean age of 47.5 (44-55) years, and those who had the standard prosthesis were 53.5 (48-56) years old (P= 0.02). The cardiopulmonary bypass time was significantly less in the Top-Hat prosthesis group with an average of 78 min (75- 81) compared to 88 min (84- 95) in the other group (P ˂0.001). The effective orifice surface area was significantly larger in the group with Top-Hat prosthesis; 0.9 mm/m2 (0.88- 0.92) compared to 0.84 mm/m 2 (0.79- 0.87) for the standard aortic valve prosthesis group (P ˂0.001). The pressure gradient over the aortic valve decreased significantly postoperatively (coefficient -1.98 (-2.21- -1.75); P˂0.001). Patients with Top-Hat valves had significantly lower gradient (coefficient: -4.22 (-6.61- -1.82); P= 0.001), while age had no effect on the pressure gradient (coefficient: 0.1 ( -0.07- 0.27); P= 0.25). Conclusion: The Top-Hat CarboMedics prostheses could be superior to the standard CarboMedics aortic valve prosthesis regarding the effective orifice area and pressure gradient over the valve.
Introduction: Automated knot fastener has been used in minimally invasive valve surgery to alleviate the longer total operating time and improve outcomes. Their advantages over manual knot tying remain questionable. This study aims to compare automated knot fasteners' efficacy with conventional knot-pushers in minimally invasive mitral valve replacements (MiMVR). Methods: Between 2016 and 2020, 50 patients underwent isolated mechanical mitral valve replacement via right mini-thoracotomy in rheumatic or degenerative mitral valve disease. The patients were grouped into two groups. Group I (n= 25) included patients who had MiMVR using the Cor-knot device, and Group II (n= 25) had MiMVR using the conventional knot-pusher. Primary endpoints were cross-clamp, cardiopulmonary bypass, and total operative times and the secondary outcomes were paravalvular leak and reoperation. There were no significant differences in the demographic data between the two groups. Results: Cross-clamp time (79± 1.11 vs. 98.88± 1.34 min; P<0.001), cardiopulmonary bypass time ( 132 (Q1- Q2: 129- 134) vs. 148 (140- 155) min; P<0.001) and operative times ( 206 (203- 209) vs. 228 (223- 234) min; P<0.001) were significantly shorter in Group I. There was no difference in postoperative complications between groups. The early paravalvular leak occurred in one patient (4%) in Group I and required valve re-exploration. In Group II, four patients (16%) had a paravalvular leak; 3 of them were severe and required valve re-exploration (P= 0.35). Transthoracic echocardiography at discharge revealed no evidence of a paravalvular leak in both groups. Conclusion: Automated fastener device (Cor-knot) could reduce operative times during minimally invasive mitral valve replacement. Operative complications are comparable between both techniques, and follow-up studies are recommended.
Background: High-risk patients are currently presenting for aortic valve replacement (AVR). Sutureless valves may decrease the operative risk in those patients. The objective of this study was to compare the short-term and one-year follow-up results of the sutureless Perceval valve versus bioprosthetic aortic valve. Methods: The data of patients who underwent elective AVR with bioprosthesis were collected From March 2012 to March 2017. The patients were divided into two groups; group 1 included the patients who had a sutureless aortic valve (Perceval) (n= 25; 3.57% of total AVR patients), and group 2 included patients who had conventional bioprosthesis (n= 50; 7.1% of total AVR patients). Results: The median age of patients in group 1 was 67 years (25th- 75th percentiles; 64-71), and in group 2 was 66 years (25th- 75th percentiles: 63 to 69). There is no significant difference in the patients’ comorbidities between the two groups. The median duration of the ischemic time was significantly lower in group 1 (33 (25th- 75th percentiles: 32- 35) vs. 60.5 (58- 66), respectively; p< 0.001). Perceval valve was used more commonly in patients who had minimally invasive AVR (n= 21 (84%) in group 1 vs. 11 (22%) in group 2; p<0.001). Postoperative complications were comparable between both groups. The early paravalvular leak was non-significantly higher in group 1 (12% vs. 2%; p= 0105). The mean postoperative gradient was lower in group 1 (7 (7-9) vs. 10 (8-12) mmHg; p<0.001). The changes in valvular gradient were not significantly different between both groups (p= 0.5). The hospital stay was lower in patients received Perceval valve (Coefficient: -1.3; 95% Cl: -2.3- -0.29; p=0.012) Conclusion: Sutureless aortic valve (Perceval) is a new surgical technique for AVR, with potential advantages of reducing cross-clamp time and a subsequent reduction in myocardial ischemia, duration of cardiopulmonary bypass, and maintaining satisfactory hemodynamic outcomes through reducing patient prosthesis mismatch. All these advantages could help in decreasing postoperative hospital stay.
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