Single leaflet reconstruction in paediatric aortic regurgitation using the Ozaki procedure

Objectives: Aortic valve repair in children is still a challenge. The aim of this study was to analyse the surgical results of children with aortic regurgitation who underwent single leaflet reconstruction using the Ozaki procedure in our medical centre. Methods: A retrospective study was conducted of nine children with aortic regurgitation who received single leaflet reconstruction from May 2017 to September 2019. Paired t-tests and Wilcoxon signed rank tests were used to compare the data at different time points. Results: The median surgical age was 4.7 (3.5, 6.4) years. Eight patients were pre-operatively diagnosed with severe aortic regurgitation, while one had moderate regurgitation. The left ventricles were significantly enlarged, with an average z-score of 3.8. Single leaflet reconstruction was carried out using glutaraldehyde-treated autologous pericardium under the standard Ozaki procedure. The median follow-up was 22 (14, 33) months. There was no post-operative death or re-intervention. One patient had moderate or more aortic regurgitation during the follow-up. The average degree of aortic regurgitation was mild, and the average z-score of the left ventricle decreased to −0.2 in the last follow-up. Conclusions: Single leaflet reconstruction using the Ozaki procedure was an effective surgical method for treating children with aortic regurgitation in our centre with satisfactory short-term results.

Preoperative renal malperfusion is an independent predictor for acute kidney injury and operative death but not associated with late mortality after surgery for acute type A aortic dissection

OBJECTIVES This study was aimed to investigate the impact of preoperative renal malperfusion on early and late outcomes after surgery for acute type A aortic dissection (AAAD). METHODS Of 915 patients who underwent surgery for AAAD between September 2004 and September 2017, we enrolled 534 patients whose preoperative enhanced computed tomography images were retrospectively available in this study. Exclusion criteria were single kidney (n = 3) and dialysis-dependent preoperatively (n = 12). We compared early and late outcomes between patients who had preoperative renal malperfusion (n = 64) and those who did not have renal malperfusion (n = 470). RESULTS The incidence of postoperative acute kidney injury, defined using the Kidney Disease: Improving Global Outcomes criteria, was higher in the renal malperfusion group than in the no renal malperfusion group (76.6% vs 39.4%; P < 0.001). Similarly, operative death was more frequently seen in the renal malperfusion group (12.5% vs 3.8%; P = 0.003). Multivariate analyses showed that renal malperfusion was the independent predictor for postoperative acute kidney injury [odds ratio 4.32, 95% confidence interval (CI) 2.25–8.67; P < 0.001] and operative death (odds ratio 3.08, 95% CI 1.02–8.86; P = 0.046). The median follow-up period in the hospital survivors was 3.3 years (interquartile range 2.1–6.7 years). The cumulative survival rate at 8 years was similar between the groups (74.6% in the renal malperfusion group and 76.0% in the no renal malperfusion group; P = 0.349). CONCLUSIONS Preoperative renal malperfusion is an independent predictor for postoperative acute kidney injury and operative death but not associated with late mortality after surgery for acute type A aortic dissection.

P52 LIVER REDUCTION DIET IN PATIENTS UNDERGOING GASTRO-OESOPHAGECTOMIES

Aim The prevalence of obesity has nearly doubled in the last 10 years and is a known risk factor for oesophageal adenocarcinoma [1]. There is an increasing popularity with minimally invasive esophagectomies employing laparoscopic and/or thoracoscopic approach [2]. Obesity can complicate technical aspects of surgery. There is increased risk of retraction trauma from fatty livers and the operative field of the gastro-oesophageal area is limited in obese patients. Pre-operative liver reduction diet (LRD) is a common practice in patients undergoing bariatric surgery. We propose a pre-operative LRD for obese patients undergoing oesophago-gastric surgery for cancer to be safe and can help with the overall complexity of the surgery. Background & Methods In our regional tertiary unit, we adopted a 2-week pre-operative LRD for patients undergoing oesophago-gastric surgery with BMI >30 Kg m-2. Data was collected prospectively from January 2017 to January 2019 for all patients undergoing oesophago-gastric surgery. Results 142 patients underwent oesophago-gastric surgery in the study period, 31 with a BMI >30 Kg m-2. 20 of the 31 (64.5%) received and completed LRD prior to their operation. For 9 patients, no reason was documented for incompletion of diet and 2 were unable to manage the diet. For 75% (15/20) of these patients, surgery was randomized and completed using the hybrid approach (laparoscopic abdomen and open chest) and the rest undergoing open procedure, as per the ROMIO trial [3]. Although a small number of cases for comparison, there were no significant differences observed in length of stay (LOS), complications including pneumonia, chyle leak and anastomotic leak in our patient group receiving LRD compared to high BMI patients in the literature without LRD. Conclusion Oesophago-gastric surgeons in our unit find pre-operative LRD in obese patients leads to improved flexibility of the liver for easier retraction and a better exposure of the operating field, especially around the hiatus. Implementation of pre-operative LRD in obese patients undergoing oesophago-gastric cancer surgery has been shown to be safe. We aim to continue to record post-operative complications, peri-operative death and LOS and expand the sample size for our study.

Liver transplantation in the Novosibirsk Region: evolution of the program and its outcomes

Objective:To assess early and late outcomes of the orthotopic liver transplantation (LTx) program in the Novosibirsk Region from August 2010 to June 2018.Materials and methods:This retrospective study included 176 patients aged 41.5 ± 16.69 years (from 5 months to 69 years; median 44 years), who underwent 185 LTx procedures including nine retransplantations.Results:Some particulars of vascular and biliary reconstruction in various LTx types are discussed. The incidence of vascular and biliary complications was 1.6% and 10.3%, respectively. The duration of stay in the intensive care unit was 7 ± 7.1 days (from 0 to 69 days, median 5) and mean total duration of hospital stay was 33 ± 18.1 days (from 1 to 136 days, median 30). Early graft dysfunction was observed in 28 (15.9%) of the recipients. Perioperative (up to 90 days) mortality was 4.5% (8 recipients, including one intra-operative death). There was zero mortality in the liver fragment recipients. The overall 5-year patient and graft survival rates were 71% and 65%, respectively.Conclusion:The Novosibirsk Region has a well-established LTx program, with its outcomes being comparable to those of the leading Russian centers and large worldwide registries. In 2017, LTx prevalence was 12.9 per million of the population. Thus, the region has become one of the most provided with this type of medical care in the Russian Federation.

Total Arch versus Hemiarch Replacement for Type A Acute Aortic Dissection: A Single-Center Experience

We retrospectively evaluated early and intermediate outcomes of aortic arch surgery in patients with type A acute aortic dissection (AAD), investigating the effect of arch surgery extension on postoperative results. From January 2006 through July 2013, 201 patients with type A AAD underwent urgent corrective surgery at our institution. Of the 92 patients chosen for this study, 59 underwent hemiarch replacement (hemiarch group), and 33 underwent total arch replacement (total arch group) in conjunction with ascending aorta replacement. The operative mortality rate was 22%. Total arch replacement was associated with a 33% risk of operative death, versus 15% for hemiarch (P=0.044). Multivariable analysis found these independent predictors of operative death: age (odds ratio [OR]=1.13/yr; 95% confidence interval [CI], 1.04–1.23; P=0.002), body mass index >30 kg/m2 (OR=9.9; 95% CI, 1.28–19; P=0.028), postoperative low cardiac output (OR=10.6; 95% CI, 1.18–25; P=0.035), and total arch replacement (OR=8.8; 95% CI, 1.39–15; P=0.021) The mean overall 5-year survival rate was 59.3% ± 5.5%, and mean 5-year freedom from distal reintervention was 95.4% ± 3.2% (P=NS). In type A AAD, aortic arch surgery is still associated with high operative mortality rates; hemiarch replacement can be performed more safely than total arch replacement. Rates of distal aortic reoperation were not different between the 2 surgical strategies.

The Current Status of Emergency Operations at a High-Volume Cancer Center

This study aimed to assess the pathogenic causes, clinical conditions, surgical procedures, in-hospital mortality, and operative death associated with emergency operations at a high-volume cancer center. Although many reports have described the contents, operative procedures, and prognosis of elective surgeries in high-volume cancer centers, emergency operations have not been studied in sufficient detail. We retrospectively enrolled 28 consecutive patients who underwent emergency surgery. Cases involving operative complications were excluded. The following surgical procedures were performed during emergency operations: closure in 3 cases (10.7%), diversion in 22 cases (78.6%), ileus treatment in 2 cases (7.1%), and hemostasis in 1 case (3.6%). Closure alone was performed only once for peritonitis. Diversion was performed in 17 cases (77.3%) of peritonitis, 4 cases (18.2%) of stenosis of the gastrointestinal tract, and 1 case (4.5%) of bleeding. There was a significant overall difference (P = 0.001). The frequency of emergency operations was very low at a high-volume cancer center. However, the recent shift in treatment approaches toward nonoperative techniques may enhance the status of emergency surgical procedures. The results presented in this study will help prepare for emergency situations and resolve them as quickly and efficiently as possible.