Echocardiographic and Computed-tomographic Evaluation of the Fate of Bovine Pericardial Patch as a Pericardial Substitute in Bentall’s Procedure: Twenty-year’ Results

Objective: The study was designed to ascertain the influence of usage of bovine pericardial patch in patients undergoing Bentall’s procedure with respect to reexploration for bleeding, mediastinal infection, avoidance of conduit adhesions, late development of pericardial constriction and calcification. Materials and Methods: We reviewed 150 patients (79 males) aged between 22 to 68 years (mean±SD 49.25±12.9 years) receiving a composite aortic conduit between January 1998 to December 2020 for annuloaortic ectasia (n=100), aortic dissection (n=49), and dilated aortic root in repaired tetralogy of Fallot (n=1). Twenty-five patients had Marfan’s syndrome. Modified “button technique” was performed by interposing a glutaraldehyde treated pericardial strip at the graft coronary anastomoses, and proximal aortic conduit suturing using interlocking interrupted, pledgeted mattress suture. On completion, the pericardial cavity was reconstructed using St. Jude Medical Biocor pericardial patch. To detect evidence of pericardial constriction, survivors underwent echocardiography and computed tomography. The Kaplan-Meier curve was drawn to show the probability of survival over a period of follow-up time. Results: Seven (4.7%) patients died of cardiac-related cause, 45% had transient hemodynamic instability, 55% had low cardiac output, and 87.1% had spontaneous return of sinus rhythm. The average 12-hour postoperative drainage was 245±70 ml and there was no mediastinal infection. At a mean follow-up of 172.4 (SD± 58.9) months, the actuarial survival was 94.2±0.04% (95% CI: 88.5-96.8), and there was no pericardial constriction or calcification. Conclusion: Reconstruction of pericardial cavity using Biocor bovine pericardial patch minimizes diffuse oozing of blood, graft infection, and is not associated with later development of pericardial constriction, or calcification.

Expanded access use of rezafungin for salvage therapy of invasive Candida glabrata infection: A case report

Rezafungin is a semi-synthetic, long acting echinocandin with broad spectrum activity against many Candida species (spp)., and Aspergillus spp., including subset of drug-resistant strains. It is currently in phase III trials and was found to be safe and effective for treatment of candidemia and/or invasive Candida infections in a phase II trial. However, there are no long-term safety or efficacy data. We report on the successful ongoing compassionate use of rezafungin obtained through expanded access for over one year in a patient with a multidrug-resistant Candida glabrata mediastinal infection from a vascular graft infection and retained foreign material.

Case Report Series: Clinical Analysis of Severe Deep Neck Space Infection

BackgroundSevere deep neck space infection is rare and critical.The objective is to deepen the understanding of severe deep neck space infection and improve the level of clinical diagnosis and treatment. Case presentationA retrospective analysis of the diagnosis and treatment of 5 cases of serious deep neck infections admitted to our department. The 5 patients were all diagnosed by cervical CT and surgical exploration. 3 patients with diabetes, 2 patients with diabetic ketoacidosis, 3 patients with mediastinal infection; 3 patients underwent tracheotomy and 2 patients with tracheal intubation; All patients were treated by neck incision, drainage, dressing change and targeted antibiotics. ConclusionsSevere deep neck infections are prone to occur in patients with diabetes and other systemic basic diseases. Early diagnosis, timely neck incision exploration, drainage to maintain airway patency and targeted antibiotic treatment are the keys to diagnosis and treatment.

Transcatheter arterial embolization for delayed recurrent intrathoracic bleeding caused by anastomotic leakage after minimally invasive McKeown esophagectomy

Background: Anastomotic leakage (AL) is a serious complication after minimally invasive esophagectomy (MIE). Its development into delayed recurrent intrathoracic bleeding is very rare and may lead to fatal consequences.Case presentation: We report a case of 67-year-old female who developed intrapleural infection, mediastinal infection and delayed recurrent intrathoracic bleeding as a complication of AL following minimally invasive McKeown esophagectomy. The triple antibiotics of imipenem and cilastatin sodium, vancomycin, and fluconazole were used for anti-infection treatment. Transcatheter embolization of subclavian artery branch vessel avoided re-bleeding. As a result, the patient recovered well and was discharged 58 days after initial surgery.Conclusion: Delayed recurrent intrathoracic bleeding owing to AL is a rare and life-threatening complication after MIE. Transcatheter arterial embolization (TAE) can provide a minimally invasive and effective method to control delayed recurrent intrathoracic bleeding after esophagectomy.

TẠO HÌNH XƯƠNG ỨC VÀ THÀNH NGỰC BẰNG NẸP VÍT TRONG VẾT THƯƠNG NGỰC XUYÊN

chest wall was destroyed in the penetrating chest wound is dificult problems for a variety of conditions and has been a complex problem in the past due to intraoperative technical difficulties, surgical complications, and respiratory failure. The surgical technique of chest wall stabilization for fail chest and reconstruction with a screws plate as a part of destroyed chest wall and reconstruction is described here in this article.Cas reporte A 54-year-old male was shot in the left thorax , fired from a AK bullet at close range (plus than 3 m). He arrived to our hopital approximately 8 hours after the injury. He had absent breath sounds on the left side, rapid respiratory rate 35 L/P,upper anterior fail chets(paradoxical motion of segments of the chest wall) and his vital signs were stable (pulse was 130, blood pressure was 140/90 mmHg. Physical examination revealed a single skin laceration (plus than 2. cm) with less surrounding contusion at the left anterier-axillary line; 3th intercostal space. The admission chest radiograph revealed a all left hemothorax(pleural effusion). chest X-ray demonstrated a foreign body at the right clavicle bone with the form of an bulett (Figure 1). A leftsided thoracostomy tube drained blood, the patient underwent a traumatic thoracotomie.the bullet and ribs,1/2 anterior upper sternum, muscles on the destroyed anterior upper chest wall were removed.wide anterior chest wall defects on only shaped by steel wires and screws plate and grand pectoralis muscles to the chest wall fix (stabilisation), avoid reversal respiratory and mediastinal infection.. The patient had an uneventful hospital stay and was discharged home 25 days later.

Establishing the Safety of Training in Off-Pump Coronary Artery Bypass Surgery: A Retrospective Comparison of Outcomes between Trainees and a Consultant Surgeon

Background The safety of training in off-pump coronary artery bypass (OPCAB) surgery and the stage at which trainees should be exposed to this technique remain controversial. This single-center retrospective study aimed to compare outcomes of OPCAB surgery in consultant and trainee cases. Methods Between 2014 and 2018, all isolated OPCAB operations performed under the care of a consultant surgeon (G.A.) were analyzed. Cases where a surgeon below consultant grade performed at least 70% of the distal anastomoses were designated as “trainee cases” with the remaining cases designated as “consultant cases.” The baseline characteristics of patients, perioperative data, and short-term outcomes were prospectively collated and analyzed. Results During the study period, 245 OPCAB cases were identified: 142 (58%) consultant and 103 (42%) trainee cases. The trainee cases were performed exclusively by trainees in the final 2 years of the UK National Cardiothoracic Training Program. Both trainee and consultant groups had low mortality with two perioperative deaths occurring in either group. The rates of serious postoperative complications including stroke (n = 1 vs. 2, p = 0.759), resternotomy for bleeding (n = 3 vs. 7, p = 0.431), and mediastinal infection (n = 2 vs. 3, p = 0.926) were low and not significantly different between the two groups. Patients operated on by trainees had a slightly longer hospital stay than those operated on by the consultant surgeon, although this did not reach statistical significance (9.9 vs. 7.9 days). Conclusions These results demonstrate comparable outcomes in OPCAB surgery between a consultant surgeon and trainees. This study supports the conclusion that training surgeons in OPCAB is appropriate for trainees in the final years of cardiac surgery training.

Propionibacterium acnes Causing Mediastinal Infection following Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is now a standard of care to sample mediastinal lymph nodes and masses with high diagnostic accuracy and low complication rates. However, the procedure has potential complications that might be life-threatening. Here, we present the first case of Propionobacterium acnes (P. acnes) causing mediastinitis following EBUS-TBNA of a subcarinal lymph node.

PS01.103: THE UNUSUAL CAUSES OF ODYNOPHAGIA

Background Odynophagia can be caused by infective and non-infective inflammatory processes, benign and malignant esophageal disorders such as achalasia, gastro-esophageal reflux disease and carcinoma. Methods We described two unusual cases of odynophagia and their individual management. Results Case 1 is a 21 year-old Indian man presented with 2 days history of odynophagia after taking doxycycline capsules indicated for acne. An esophagogastroduodenoscopy (OGD) was performed and showed multiple mid esophageal ulcers. Esophageal biopsy taken showed inflammatory ulcer slough with no fungal infection, dysplasia or malignancy. Doxycycline was stopped and patient recovered with complete resolution of odynophagia. Case 2 is a 55 year-old Chinese man presented with 1 day history of odynophagia and severe chest pain after eating a bowl of hot fish soup. A CT Thorax was performed which showed a localised perforation of the right wall of the esophagus with extraluminal gas posterior to the trachea. An urgent OGD was performed and an L-shaped fish bone was removed successfully and an endoclip was applied to close the puncture hole of esophagus. Patient made a full recovery without any mediastinal infection. Conclusion Odynophagia from mid esophageal ulcers secondary to doxycycline intake should be recognized and can be easily managed by stopping the antibiotics with complete resolution of the symptom. Fish ingestion leading to sharp bone induced penetrating esophageal injury can be safely managed by endoscopic removal and endoclip application. Disclosure All authors have declared no conflicts of interest.