The predictors of postoperative paraplegia in our institution were perioperative hypotension and an open distal anastomosis technique. Avoidance of these risk factors might diminish the incidence of postoperative paraplegia.

Background: Delayed extubation after cardiac surgery is associated with high morbidity and mortality, increased intensive care unit length of stay, and healthcare cost. Acute type A aortic dissection (ATAAD) generally results in prolonged mechanical ventilation due to the complexity of surgical management and some postoperative complications. This study aimed to elucidate the perioperative risk factors for delayed extubation in patients undergoing ATAAD surgery. Methods: A retrospective cohort study including 239 patients who were diagnosed with ATAAD and underwent emergency surgery from October 2004 to January 2018 was performed. The potential perioperative risk factors for delayed extubation were collected. This study defined delayed extubation as the time to commence extubation being greater than 48 hours. The clinical data were analyzed with univariate and multivariate analyses to identify risk factors for delayed extubation following ATAAD surgery. Results: The incidence of delayed extubation was 48.5% (n=116). Multiple logistic regression analysis showed perioperative risk factors for delayed extubation included preoperative cardiac tamponade [odds ratio (OR) 3.94, 95% confidence interval (CI) 1. 39-11.17, P=0.010], central arterial cannulation (ascending aorta and proximal aortic arch) for cardiopulmonary bypass (CPB) (OR 4.

Coronary artery disease (CAD) is a significant health problem in Thailand and worldwide (World Health Organization, 2018). When the conditions cannot be controlled by optimal medication therapy, further treatment is based on coronary artery bypass graft (CABG) surgery (Neumann et al., 2019). The international guidelines recommend that the people with stable CAD who are likely to benefit from undergoing CABG for revascularization should have CABG performed within 6 weeks (Neumann et al., 2019). In Thailand, more than 5,000 CABG operations are carried out each year, and the demand for surgery continues to increase

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Tracheoesophageal fistulas (TEFs) have traditionally been managed surgically, but the endoscopic approach is widely performed as a less invasive alternative. Different closure techniques have been proposed with inconsistent results. An over-the-scope clip (OTSC) appears to be a reasonable option, but long-term results have not been well defined. We report the long-term outcomes of a complex case of successful closure of a benign refractory TEF using an OTSC after failed surgical management and esophageal stent placement.

Background Open total arch replacement is one of the most challenging procedures in cardiothoracic surgery and is the gold standard treatment for aortic arch pathology. Total arch replacement is associated with high rates of mortality and neurological morbidity. Using 14 years of data, we studied postoperative, in-hospital mortality, major complications, and examined associated risk factors. Materials and method Medical records of patients who underwent open, total arch replacement surgery at Siriraj Hospital from 2006 to December 2019 were reviewed. Demographic data, clinical factors, preoperative status, intraoperative data, and postoperative data were analyzed. Result A total of 330 patients were included and 36 (10.9%) died in the hospital. More than one concomitant operation (odds ratio (OR) 5.16, p < 0.001) and emergency operation (OR 3.45, p = 0.003) were risk factors for in-hospital mortality. Major postoperative morbidity occurred in 124 (37.7%) patients (124 of 329). Emergency operation (OR 2.88, p <0.001), preoperative creatinine clearance < 60 ml/ min/ 1.73 m2 (OR 2.04, p = 0.004), and aortic cross-clamp time > 180 min (OR 1.75, p = 0.022) were risk factors for major postsurgical complications. Conclusion In-hospital mortality after total arch replacement was 10.9% compared to international reports. Emergency operation was a major risk factor for both mortality and major complications. More than one concomitant operation, especially coronary artery bypass graft, more than doubled the risk of major complications.

Background To develop a perfused cadaveric model for trauma surgery simulation, and to evaluate its efficacy in trauma resuscitation advanced surgical skills training. Methods Fourteen fourth-year general surgery residents attended this workshop at Siriraj Hospital (Bangkok, Thailand). Inflow and outflow cannulae and a cardiopulmonary bypass pump were used to create the perfusion circuit. Inflow was achieved by cannulating the right common carotid artery, and outflow by cannulation of both the right common femoral artery and the internal jugular vein. Arterial line monitoring was used to monitor resuscitation response and to control perfusion pressure. The perfusion solution comprised saline solution mixed 1:1 with glycerol (50%) and water with red food dye added. Advanced surgical skills during life-threatening injuries and damage control resuscitation operations were practiced starting from the airway to the neck, chest, peripheral vessels, abdomen, and pelvis. Resuscitative endovascular balloon occlusion of the aorta (REBOA) was also practiced. Post-workshop survey questions were grouped into three categories, including comparison with previous training methods; the realism of anatomical correlation and procedures; and, satisfaction, safety, and confidence. All questions and tasks were discussed among all members of the development team, and were agreed upon by at least 90% of experts from each participating medical specialty/subspecialty. Results The results of the three main groups of post-workshop survey questions are, as follows: (1) How the training compared with previous surgical training methods—mean score: 4.26/5.00, high score: 4.73/5.00; (2) Realism of anatomical correlation and procedures—mean score: 4.03/5.00, high score: 4.60/5.00; and, (3) Satisfaction, safety, and confidence—mean score: 4.24/5.00, high score: 4.47/5.00. Conclusion The developed perfused cadaveric model demonstrated potential advantages over previously employed conventional surgical training techniques for teaching vascular surgery at our center as evidenced by the improvement in the satisfaction scores from students attending perfused cadaveric training compared to the scores reported by students who attended earlier training sessions that employed other training techniques. Areas of improvement included ‘a more realistic training experience’ and ‘improved facilitation of decision-making and damage control practice during trauma surgery’.

Objective: Bioprosthesis has been used in cardiac valve replacement for a long time. However, structural valve deterioration is still a major cause of failure. There are several risk factors for valve deterioration. This study evaluates the risk factors of valve deterioration in the long term (10 years) at Siriraj Hospital.Materials and Methods: We retrospectively reviewed the medical records of 249 patients who underwent mitral or aortic valve replacement between January 2006 and December 2012 using various tissue valves, comprising Carpentier–Edwards porcine, Carpentier–Edwards Perimount bovine pericardial, Carpentier–Edwards Perimount Magna bovine pericardial, and St Jude Trifecta bovine pericardial types. The information from each patient was entered into a database at the time of the operation and followed up regularly, with a mean follow-up of 10 years.Results: After 10 years follow-up time, the incidence of valve deterioration events were 1.2% and 8.43% in the first five and ten years, respectively. The overall death rate during follow-up was 2.41%. There were three statistically significant risk factors (p < 0.05) of valve deterioration: gender (female) (p = 0.042), age ≤ 60 years old (p = 0.010) and St Jude Trifecta bovine pericardial valve (p = 0.004).Conclusion: In the surgical populations who underwent valve replacement at Siriraj Hospital with tissue valves, we found an acceptable long-term durability of the tissue valve. The risk factors of valve deterioration were female gender, age ≤ 60 years old, and St Jude Trifecta bovine pericardial valve.