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Cleveland JD, Wells WJ. The Surgical Approach to Pulmonary Valve Replacement. Semin Thorac Cardiovasc Surg 2022; 34:1256-1261. [PMID: 35584775 DOI: 10.1053/j.semtcvs.2022.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 05/05/2022] [Accepted: 05/06/2022] [Indexed: 11/11/2022]
Affiliation(s)
- John D Cleveland
- Division of Cardiac Surgery, Department of Surgery, Children's Hospital Los Angeles, Los Angeles, CA
| | - Winfield J Wells
- Division of Cardiac Surgery, Department of Surgery, Children's Hospital Los Angeles, Los Angeles, CA.
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Brown JA, Sultan I. Commentary: Reoperative cardiac surgery: The importance of surgeon judgment. J Thorac Cardiovasc Surg 2021; 164:1769-1771. [PMID: 33610361 DOI: 10.1016/j.jtcvs.2021.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 01/10/2021] [Accepted: 01/11/2021] [Indexed: 11/30/2022]
Affiliation(s)
- James A Brown
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pa
| | - Ibrahim Sultan
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pa; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa.
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Ferraz Cavalcanti PE, Sá MPBO, Lins RFDA, Cavalcanti CV, Lima RDC, Cvitkovic T, Bobylev D, Boethig D, Beerbaum P, Sarikouch S, Haverich A, Horke A. Three-step preoperative sequential planning for pulmonary valve replacement in repaired tetralogy of Fallot using computed tomography. Eur J Cardiothorac Surg 2020; 59:ezaa346. [PMID: 33221863 PMCID: PMC7954262 DOI: 10.1093/ejcts/ezaa346] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 06/25/2020] [Accepted: 07/12/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Our goal was to compare results between a standard computed tomography (CT)-based strategy, the 'three-step preoperative sequential planning' (3-step PSP), for pulmonary valve replacement in repaired tetralogy of Fallot versus a conventional planning approach. METHODS We carried out a retrospective study with unmatched and matched groups. The 3-step PSP comprised the planning of mediastinal re-entry, cannulation for cardiopulmonary bypass (CPB) and the main procedure, using standard 3-dimensional videos. Operative times (skin incision to CPB, CPB time, end of CPB to skin closure and cross-clamp time) as well as postoperative length of stay and in-hospital mortality were compared. RESULTS Eighty-two patients (49% classical tetralogy of Fallot) underwent an operation (85% with pulmonary homograft) with 1.22% in-hospital mortality. The 3-step PSP (n = 14) and the conventional planning (n = 68) groups were compared. There were no statistically significant differences in the preoperative characteristics. Differences were observed in the total operative time (P = 0.009), skin incision to CPB (P = 0.034) and cross-clamp times (74 ± 33 vs 108 ± 47 min; P = 0.006), favouring the 3-step PSP group. Eight matched pairs were compared showing differences in the total operative time (263 ± 44 vs 360 ± 66 min; P = 0.008), CPB time (123 ± 34 vs 190 ± 43 min; P = 0.008) and postoperative length of stay (P = 0.031), favouring the 3-step PSP group. CONCLUSIONS In patients with repaired tetralogy of Fallot undergoing pulmonary valve replacement, preoperative planning using a standard CT-based strategy, the 3-step PSP, is associated with shorter operative times and shorter postoperative length of stay.
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Affiliation(s)
- Paulo Ernando Ferraz Cavalcanti
- Division of Cardiovascular Surgery of PROCAPE, University of Pernambuco, Pernambuco, Brazil
- Nucleus of Postgraduate and Research in Health Sciences, Faculty of Medical Sciences and Biological Sciences Institute, University of Pernambuco, Pernambuco, Brazil
| | - Michel Pompeu Barros Oliveira Sá
- Division of Cardiovascular Surgery of PROCAPE, University of Pernambuco, Pernambuco, Brazil
- Nucleus of Postgraduate and Research in Health Sciences, Faculty of Medical Sciences and Biological Sciences Institute, University of Pernambuco, Pernambuco, Brazil
| | | | | | - Ricardo de Carvalho Lima
- Division of Cardiovascular Surgery of PROCAPE, University of Pernambuco, Pernambuco, Brazil
- Nucleus of Postgraduate and Research in Health Sciences, Faculty of Medical Sciences and Biological Sciences Institute, University of Pernambuco, Pernambuco, Brazil
| | - Tomislav Cvitkovic
- Department of Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Dmitry Bobylev
- Department of Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Dietmar Boethig
- Department of Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany
- Department of Pediatric Cardiology and Pediatric Intensive Care, Hannover Medical School, Hannover, Germany
| | - Philipp Beerbaum
- Department of Pediatric Cardiology and Pediatric Intensive Care, Hannover Medical School, Hannover, Germany
| | - Samir Sarikouch
- Department of Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Axel Haverich
- Department of Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Alexander Horke
- Department of Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany
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Brown JA, Kilic A, Aranda‐Michel E, Serna‐Gallegos D, Habertheuer A, Bianco V, Thoma FW, Navid F, Sultan I. The long‐term impact of peripheral cannulation for redo cardiac surgery. J Card Surg 2020; 35:1920-1926. [DOI: 10.1111/jocs.14852] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- James A. Brown
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery University of Pittsburgh Pittsburgh Pennsylvania
| | - Arman Kilic
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery University of Pittsburgh Pittsburgh Pennsylvania
- Heart and Vascular Institute University of Pittsburgh Medical Center Pittsburgh Pennsylvania
| | - Edgar Aranda‐Michel
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery University of Pittsburgh Pittsburgh Pennsylvania
| | - Derek Serna‐Gallegos
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery University of Pittsburgh Pittsburgh Pennsylvania
| | - Andreas Habertheuer
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery University of Pittsburgh Pittsburgh Pennsylvania
| | - Valentino Bianco
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery University of Pittsburgh Pittsburgh Pennsylvania
| | - Floyd W. Thoma
- Heart and Vascular Institute University of Pittsburgh Medical Center Pittsburgh Pennsylvania
| | - Forozan Navid
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery University of Pittsburgh Pittsburgh Pennsylvania
- Heart and Vascular Institute University of Pittsburgh Medical Center Pittsburgh Pennsylvania
| | - Ibrahim Sultan
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery University of Pittsburgh Pittsburgh Pennsylvania
- Heart and Vascular Institute University of Pittsburgh Medical Center Pittsburgh Pennsylvania
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Villa-Hincapie CA, Carreno-Jaimes M, Obando-Lopez CE, Camacho-Mackenzie J, Umaña-Mallarino JP, Sandoval-Reyes NF. Risk Factors for Mortality in Reoperations for Pediatric and Congenital Heart Surgery in a Developing Country. World J Pediatr Congenit Heart Surg 2017; 8:435-439. [PMID: 28696882 DOI: 10.1177/2150135117704657] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The survival of patients with congenital heart disease has increased in the recent years, because of enhanced diagnostic capabilities, better surgical techniques, and improved perioperative care. Many patients will require reoperation as part of staged procedures or to treat grafts deterioration and residual or recurrent lesions. Reoperations favor the formation of cardiac adhesions and consequently increase surgery time; however, the impact on morbidity and operative mortality is certain. The objective of the study was to describe the risk factors for mortality in pediatric patients undergoing a reoperation for congenital heart disease. METHODS Historic cohort of patients who underwent reoperation after pediatric cardiac surgery from January 2009 to December 2015. Operations with previous surgical approach different to sternotomy were excluded from the analysis. RESULTS In seven years, 3,086 surgeries were performed, 481 were reoperations, and 238 patients fulfilled the inclusion criteria. Mean number of prior surgeries was 1.4 ± 0.6. Median age at the time of reoperation was 6.4 years. The most common surgical procedures were staged palliation for functionally univentricular heart (17.6%). Median cross-clamp time was 66 minutes. Younger age at the moment of resternotomy, longer cross-clamp time, and Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery Congenital Heart Surgery (STAT) Mortality Categories risk category greater than three were risk factors for mortality. The number of resternotomies was not associated with mortality. Mortality prior to hospital discharge was 4.6%, and mortality after discharge but prior to 30 days after surgery was 0.54%. Operative mortality was 5.1%. CONCLUSIONS Resternotomy in pediatric cardiac surgery is a safe procedure in our center.
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Affiliation(s)
- Carlos A Villa-Hincapie
- 1 Fundación Cardioinfantil (FCI), Instituto de Cardiología. Department of Congenital Heart Disease. Bogotá, Colombia.,2 Universidad del Rosario. Bogotá, Colombia
| | - Marisol Carreno-Jaimes
- 1 Fundación Cardioinfantil (FCI), Instituto de Cardiología. Department of Congenital Heart Disease. Bogotá, Colombia
| | - Carlos E Obando-Lopez
- 1 Fundación Cardioinfantil (FCI), Instituto de Cardiología. Department of Congenital Heart Disease. Bogotá, Colombia.,2 Universidad del Rosario. Bogotá, Colombia
| | - Jaime Camacho-Mackenzie
- 1 Fundación Cardioinfantil (FCI), Instituto de Cardiología. Department of Congenital Heart Disease. Bogotá, Colombia.,2 Universidad del Rosario. Bogotá, Colombia
| | - Juan P Umaña-Mallarino
- 1 Fundación Cardioinfantil (FCI), Instituto de Cardiología. Department of Congenital Heart Disease. Bogotá, Colombia.,2 Universidad del Rosario. Bogotá, Colombia
| | - Nestor F Sandoval-Reyes
- 1 Fundación Cardioinfantil (FCI), Instituto de Cardiología. Department of Congenital Heart Disease. Bogotá, Colombia.,2 Universidad del Rosario. Bogotá, Colombia
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Salehi M, Bakhshandeh AR, Saberi K, Alemohammad M, Sobhanian K, Karamnezhad M, Rigi FS. Resternotomy, a single-center experience. Asian Cardiovasc Thorac Ann 2016; 25:13-17. [PMID: 27784819 DOI: 10.1177/0218492316678119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Reoperations are technically more difficult because of the risks associated with reentry in a heart with more advanced pathology, little reserve, and more frequent comorbidities. Routine peripheral cannulation before resternotomy is inadvisable, time-consuming, and has no noticeable role in decreasing the risks of reentry. We present our experience of resternotomy without routine peripheral cannulation. Methods This was a retrospective study on 237 consecutive patients who underwent resternotomy between June 2011 and July 2013. Their mean age was 47.7 ± 18.2 years. We chose the best approach individually, according to lateral radiograph findings, patient risk factors, and previous surgery. Our goal was to observe events intraoperatively and their outcomes postoperatively. Results Mean intensive care unit stay was 3.1 ± 0.9 days. Twenty-one (8.8%) patients died during their hospital stay. The most common cause of death was renal failure in 15 (71.4%) patients, coagulopathy in 4 (19%), and cardiac failure in 2 (9.5%). We had 3 right ventricular, one right atrial, one pulmonary artery, and 2 inferior vena caval tears during resternotomy and dissection; bleeding was controlled easily without peripheral cannulation. Femoral cannulation before resternotomy was performed in one patient who needed an emergency pulmonary embolectomy. Conclusions Based on our experience, resternotomy with central cannulation is a safe strategy, and peripheral cannulation before resternotomy should be reserved for highly selected patients.
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Affiliation(s)
- Mehrdad Salehi
- 1 Department of Cardiovascular Surgery, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Reza Bakhshandeh
- 1 Department of Cardiovascular Surgery, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Kianoush Saberi
- 2 Department of Anesthesia, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahmood Alemohammad
- 2 Department of Anesthesia, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Keivan Sobhanian
- 1 Department of Cardiovascular Surgery, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Maziar Karamnezhad
- 1 Department of Cardiovascular Surgery, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Farangis Sarouneh Rigi
- 1 Department of Cardiovascular Surgery, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
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Kirmani BH, Brazier A, Sriskandarajah S, Azzam R, Keenan DJ. A meta-analysis of computerized tomography scan for reducing complications following repeat sternotomy for cardiac surgery. Interact Cardiovasc Thorac Surg 2016; 22:472-9. [DOI: 10.1093/icvts/ivv367] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 11/25/2015] [Indexed: 11/15/2022] Open
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