A Treatment Case of Endoscopic Removal of Left Ventricular Thrombus, During Coronary Artery Bypass Graft

Park, Hyun-Seok; Ryu, Se-Min; Cho, Seong-Joon; Park, Sung Min; Lim, Sun-Hye

doi:10.5090/kjtcs.2014.47.4.434

Cited by 3 publications

(4 citation statements)

References 6 publications

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“…In 12 studies, the follow-up was longer than 30-days and no mortalities were observed [2, 3, 5, 6, 8, 9, 12, 25, 26, 31, 33, 35]. The only postoperative complication observed was one case of atrial fibrillation (2.2%, 1/46).…”

Section: Resultsmentioning

confidence: 99%

“…In 13 studies, the type of endoscope used was not specified [ 4 , 6 , 10 , 15 , 20 , 24 – 28 , 31 , 34 , 35 ]. Other adjunct endoscopic instruments such as forceps, graspers, scissors, suckers or retractors were used in 13 studies [ 2 , 3 , 12 , 13 , 15 , 19 , 21 , 25 , 30 , 32 , 34 , 35 , 37 ]. In the remaining it was not clear whether open surgical or endoscopic instruments were used.…”

Section: Resultsmentioning

confidence: 99%

“…There were no mortalities (0/47) among 27 studies at last recorded follow-up (Table 2 ) [ 2 – 13 , 15 , 19 , 21 – 28 , 31 – 35 ]. In 12 studies, the follow-up was longer than 30-days and no mortalities were observed [ 2 , 3 , 5 , 6 , 8 , 9 , 12 , 25 , 26 , 31 , 33 , 35 ]. The only postoperative complication observed was one case of atrial fibrillation (2.2%, 1/46).…”

Section: Resultsmentioning

confidence: 99%

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A systematic review of left ventricular cardio-endoscopic surgery

Soylu

Kidher

Ashrafian

et al. 2017

J Cardiothorac Surg

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Better visualisation, accurate resection and avoidance of ventriculotomy associated with use of endoscopic devices during intracardiac surgery has led to increasing interest in their use. The possibility of combining a cardio-endoscopic technique with either minimally invasive or totally endoscopic cardiac surgery provides an incentive for its further development. Several devices have been used, however their uptake has been limited due to uncertainty around their impact on patient outcomes. A systematic review of the literature identified 34 studies, incorporating 54 subjects undergoing treatment of left ventricular tumours, thrombus or hypertrophic myocardium using a cardio-endoscopic technique. There were no mortalities (0%; 0/47). In 12 studies, the follow-up period was longer than 30 days. There were no post-operative complications apart from one case of atrial fibrillation (2.2%; 1/46). Complete resection of left ventricular lesion was achieved in all cases (100%; 50/50). These successful results demonstrate that the cardio-endoscopic technique is a useful adjunct in resection of left ventricular tumours, thrombus and hypertrophic myocardium. This approach facilitates accurate resection of pathological tissue from left ventricle whilst avoiding exposure related valvular damage and adverse effects associated with ventriculotomy. Future research should focus on designing adequately powered comparative randomised trials focusing on major cardiac and cerebrovascular morbidity outcomes in both the short and long-term. In this way, we may have a more comprehensive picture of both the safety and efficacy of this technique and determine whether such devices could be safely adopted for routine use in minimal access or robotic intra-cardiac surgery.Electronic supplementary materialThe online version of this article (doi:10.1186/s13019-017-0599-z) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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A systematic review of left ventricular cardio-endoscopic surgery

Soylu

Kidher

Ashrafian

et al. 2017

J Cardiothorac Surg

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“…Despite the scarcity of available data, surgical removal of LVT was not proposed because the risk of embolism caused by LVT may not outweigh the surgical risks. 4 Nearly all the studies of surgically removing LVT were case reports 5 , 6 and lacked high‐quality research or evidence to instruct clinical practice of managing LVT patients who underwent left ventricular thrombectomy.…”

Section: Introductionmentioning

confidence: 99%

Is 3–6 months anticoagulation with warfarin necessary after left ventricular thrombectomy with left ventricular aneurysm surgery?

Zhang

Huang

Tiemuerniyazi

et al. 2022

Journal of Cardiac Surgery

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Objectives: No recommendation exists on the optimal antithrombotic therapy after left ventricular thrombus (LVT) resection in the current guidelines. The study aimed to investigate the role of prophylactic anticoagulation with warfarin for 3-6 months in LVT recurrence and other clinical outcomes after LVT resection and left ventricular aneurysm (LVA) surgery.Methods: All consecutive patients undergoing LVT resection together with LVA surgery in our institution between 2010.1.1 and 2021.4.1 were included in the study. Individuals included were divided into two groups based on whether warfarin was administered at discharge. Patients with warfarin were matched to their counterparts without warfarin based on the baseline characteristics via propensity score matching (PSM) at the ratio of 1:1. The primary outcome was LVT recurrence.The secondary outcomes were major adverse cardiac and cerebrovascular events (MACCEs) and the composite endpoint of LVT recurrence and MACCEs.Results: After PSM, a total of 118 patients were included in the study, among whom 59 received warfarin therapy at discharge and 59 didn't. During the median followup of 56.5 months, 21 out of 118 patients had LVT recurrence and the recurrence rate was 17.8% There was no systemic embolism resulting from the recurrent LVT.Kaplan-Meir analysis showed no significant difference in LVT recurrence (p = .86), MACCEs (p = .48) and the composite endpoint of LVT recurrence, and MACCEs (p = .89). Cox proportional hazards regression model showed that history of PCI (hazard ratio [HR] 2.778, 95% confidence interval [CI] 1.087-7.100, p = .033) and LVA surgical strategy of linear suture (HR 8.768, p = .037) were independent risk factors of LVT recurrence.

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Video assisted, transaortic removal of left ventricular thrombus during concurrent cardiac surgery: a case report

Eranki

Villanueva

Collins

et al. 2021

J Cardiothorac Surg

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Introduction Left ventricular (LV) thrombus is a complication of acute myocardial infarction and is associated with systemic thromboembolism. We describe a trans-aortic endoscopic approach to the removal of an LV thrombus in a patient undergoing concurrent coronary artery bypass grafting and aortic valve replacement. Case presentation A 47 year old male presented following an embolic middle cerebral artery stroke and underwent transthoracic echocardiography demonstrating a mobile LV thrombus. Additional investigation revealed a moderately stenosed bicispid aortic valve, two vessel coronary artery disease and ischemic cardiomyopathy. The patient underwent early surgery to reduce the risk of further embolic episodes. A trans-aortic approach was utilized with videoscopy and single shafted instrumentation to aide in removal of the thrombus. The patient then underwent aortic valve replacement and coronary artery bypass grafting. Conclusion We report an alternative technique for the removal of a left ventricular thrombus in a patient undergoing concurrent coronary and aortic valve surgery. The transaortic video-assisted approach provided excellent visualisation of the apex and near complete removal of the thrombus without damaging the surrounding trabeculae. The main benefit of this technique is sparing of LV tissue, thereby preserving left ventricular function.

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A Treatment Case of Endoscopic Removal of Left Ventricular Thrombus, During Coronary Artery Bypass Graft

Cited by 3 publications

References 6 publications

A systematic review of left ventricular cardio-endoscopic surgery

A systematic review of left ventricular cardio-endoscopic surgery

Is 3–6 months anticoagulation with warfarin necessary after left ventricular thrombectomy with left ventricular aneurysm surgery?

Video assisted, transaortic removal of left ventricular thrombus during concurrent cardiac surgery: a case report

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