Avoiding patient-prosthesis mismatch (PPM) in patients with small aortic annulus (SAA) during aortic valve replacement (AVR) is still a challenging surgical problem. Among surgical options available, ...aortic root enlargement (ARE) and stentless valve implantation (SVI) are the two most commonly used strategies. This systematic review will be conducted searching for superiority evidence based on comparative studies between these two options.INTRODUCTIONAvoiding patient-prosthesis mismatch (PPM) in patients with small aortic annulus (SAA) during aortic valve replacement (AVR) is still a challenging surgical problem. Among surgical options available, aortic root enlargement (ARE) and stentless valve implantation (SVI) are the two most commonly used strategies. This systematic review will be conducted searching for superiority evidence based on comparative studies between these two options.This systematic review will include all relevant articles published from 1 January 1946 to 31 March 2024, with available full texts from Medline (Ovid), Embase, Cochrane Library and Web of Science databases, without any language restriction. Observational studies and randomised controlled trials comparing surgical results of ARE versus SVI for AVR in patients with small aortic root will be screened. Studies will be classified into three groups: group 1 for studies that reported SVI or other tissue valve outcomes without comparing them with ARE outcomes; group 2 for studies that reported ARE outcomes without comparing them with SVI outcomes; and group 3 for studies that compared ARE outcomes with SVI outcomes. The quality of the evidence of each study will be evaluated according to Oxford Centre for Evidence-Based Medicine criteria.METHODS AND ANALYSISThis systematic review will include all relevant articles published from 1 January 1946 to 31 March 2024, with available full texts from Medline (Ovid), Embase, Cochrane Library and Web of Science databases, without any language restriction. Observational studies and randomised controlled trials comparing surgical results of ARE versus SVI for AVR in patients with small aortic root will be screened. Studies will be classified into three groups: group 1 for studies that reported SVI or other tissue valve outcomes without comparing them with ARE outcomes; group 2 for studies that reported ARE outcomes without comparing them with SVI outcomes; and group 3 for studies that compared ARE outcomes with SVI outcomes. The quality of the evidence of each study will be evaluated according to Oxford Centre for Evidence-Based Medicine criteria.Ethical approval is not required because no primary data are collected. The findings will be presented at scientific conferences and/or reported in a peer-reviewed scientific journal.ETHICS AND DISSEMINATIONEthical approval is not required because no primary data are collected. The findings will be presented at scientific conferences and/or reported in a peer-reviewed scientific journal.PROSPERO, CRD42023383793.TRIAL REGISTRATION NUMBERPROSPERO, CRD42023383793.
Background
Surgical skills acquisition in cardiac surgery requires consistent and hard practice. Furthermore, training using cadaver is advocated as a means of transferring learned skills to the ...operating room and recreate surgical situations for trainees to practice and hone their skills. We expose our experience in training for cardiac surgical procedures using human cadavers.
Methods
From June 2013 to November 2016, we performed 302 cardiac surgical procedures on 50 human cadavers obtained according to the Ivorian laws in force. Cadavers were preserved in 10% formaldehyde and by cryopreservation.
Results
In open heart, cardiac surgical techniques were achieved via sternotomy (n = 24) or via “lid‐anterolateral thoracotomy” (n = 2). Pericardotomy (n = 26) and/or pericardiectomy (n = 26) were systematic. Aortic and caval canulations and pulmonary artery control (n = 30) were performed. After cardiotomy and arterial incisions (n = 34), 18 atrial and ventricular septal defects repair, 1 Fontan operation, 1 arterial switch, 11 enlargement procedures of the whole right ventricular outlet and 15 acquired valve heart diseases corrections were performed. In closed‐heart surgery, procedures were achieved via sternotomy (n = 7), posterolateral thoracotomy (n = 12), or Marfan retroxiphoid approach (n = 3). Pericardotomy (n = 7) or pericardiectomy (n = 7) were performed. Great vessels dissections and expositions (n = 21) were achieved to perform 4 pulmonary artery bandings, 12 patent ductus arteriosus closures, 3 Waldhausen procedures, 7 Brock Operations, and 2 Blalock‐Taussig shunts. In both situations, 29 direct pulmonary arterial, auricular, and ventricular sutures were achieved.
Conclusion
Surgical simulation in cadaver models offer an opportunity for trainees to practice their surgical skills before entering operating room.
Long-term outcome of the in situ versus free internal thoracic artery as the second arterial graft Marzouk, Mohamed; Kalavrouziotis, Dimitri; Grazioli, Valentina ...
Journal of thoracic and cardiovascular surgery/The Journal of thoracic and cardiovascular surgery/The journal of thoracic and cardiovascular surgery,
December 2021, 2021-12-00, 20211201, Letnik:
162, Številka:
6
Journal Article
Recenzirano
Odprti dostop
The study objective was to determine the impact on outcome associated with using the second internal thoracic artery as a free compared with an in situ graft among patients who received the first ...internal thoracic artery as an in situ internal thoracic artery to the left anterior descending artery.
Among 2600 patients who underwent bilateral internal thoracic artery with an in situ internal thoracic artery to the left anterior descending artery, the second internal thoracic artery was used as a free graft bilateral internal thoracic artery in 136 patients and as an in situ graft (in situ bilateral internal thoracic artery) in 2464 patients. One-to-many propensity score matching was performed to produce a cohort of 134 patients with a second free graft internal thoracic artery matched to 2359 patients with a second in situ internal thoracic artery. Early and long-term outcomes including survival, hospital readmission, and repeat revascularization up to a maximum of 25.8 years were compared.
There were no differences between the 2 matched groups' preoperative baseline characteristics and early adverse events. Long-term survival at 5, 10, and 15 years was significantly higher among patients with an in situ bilateral internal thoracic artery compared with patients with a free graft bilateral internal thoracic artery (hazard ratio free graft bilateral internal thoracic artery vs in situ bilateral internal thoracic artery, 1.53; 95% confidence interval, 1.14-2.10; P = .004). However, the long-term risk of readmission to the hospital for cardiovascular reasons and need for repeat revascularization were not significantly different between the 2 matched groups.
In a small, propensity-matched cohort of patients undergoing coronary artery bypass grafting, the use of a second in situ internal thoracic artery was associated with an increase in late survival compared with the use of a second internal thoracic artery as a free graft. However, the risk of late hospital readmission and the need for repeat revascularization were similar.
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The bronchial dilations also called bronchiectasis are permanent and irreversible increase in the bronchial tubes. They can be extended or localized especially in pulmonary tuberculosis sequelae. ...This affection is serious, because it is at the origin of an embarrassing obstructive pulmonary disease, leading to social discomfort and preferentially in Côte d'Ivoire, it affects young subjects between 30 and 40 years old and former tuberculous. The place of surgery is still debated. Mr Coulibaly is 30 years old, hospitalized in the Thoracic Surgery Department of BouakeTeaching Hospital for pulmonary tuberculosis sequelae type symptomatic left lower bronchiectasis lobe and well localized (A). After a satisfactory preoperative evaluation, we performed a left lower lobectomy on this patient. Transection in the third world of the bronchial lower lobe resected reveals multiple tubular dilations with thickened wall containing purulent secretions (B). The specimen was sent to the pathology laboratory for confirmation of tuberculosis sequelae.
Cette étude rapporte les aspects cliniques et évolutifs des séquelles pulmonaires tuberculeuses (SPT) opérées chez les séropositifs (VIH+). Il s'agit d'une étude prospective transversale réalisée ...entre Novembre 2005 et Octobre 2012. Elle a porté sur 20 patients VIH+, ayant dans leurs antécédents, une tuberculose pulmonaire (TP) traitée et déclarée guérie, et admise dans ladite période pour une chirurgie de la SPT secondaire. Une enquête sérologique VIH a été réalisée systématiquement au cours du bilan pré-opératoire. Le diagnostic pré-opératoire de la SPT, la mortalité, les complications post- opératoires (CPOP), le séjour hospitalier, le suivi à moyen terme des STP opérées ont été évalués. Les séropositifs étaient VIH1+ (n = 12; 60%), VIH1&2+ (n = 4; 20%) et VIH2+ (n = 4; 20%). La durée moyenne d’évolution des STP était de 26,22 ± 21,3 mois. Les STP étaient les pyothorax ou pleurésies enkystées (n = 16; 80%), le poumon détruit (n = 2;10%) et les dilatations de bronches (n = 2;10%). Les VIH
+
ne présentaient pas d'aspergillome pulmonaire. Le séjour hospitalier moyen était 13,1 ± 10,2 jours. Le suivi total était de 82 patients-année avec une moyenne de suivi de 4,2 ± 2,3 ans (extrêmes: 1 et 7 ans). Le taux de mortalité à court et moyen terme était nul. Aucun décès post-opératoire immédiat n'a été noté. Les CPOP immédiates étaient les bullages prolongés chez 75% des immunodéprimés. Les CPOP tardives (n = 3) étaient un syndrome restrictif pulmonaire, un pyothorax persistant et une pachypleurite résiduelle restrictive. A court terme, le taux de guérison radiologique était de 80% (n = 16).
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