Background: Partial anomalous pulmonary venous connection (PAPVC) occurs when at least one pulmonary vein drains into the right atrium or its tributaries rather than the left atrium, most commonly connecting with the superior vena cava (SVC). The Warden procedure involves transecting the SVC proximal to the uppermost connection of the pulmonary vein followed by proximal SVC reattachment to the right atrial appendage. However, descending thoracic aortic homograft replacement for SVC translocation has recently been introduced as a modified technique. Aims: This commentary aims to discuss the recent study by Said and colleagues who reported their experiences with 6 PAPVC cases undergoing a modified Warden procedure using thoracic aortic homograft SVC translocation. Methods: A comprehensive literature search was performed using multiple electronic databases in order to collate the relevant research evidence. Results: The Warden procedure is associated with a 10% incidence of SVC obstruction with many requiring reintervention. Meanwhile, using the aortic homograft for SVC translocation, Said et al. observed no SVC obstructions. In addition, this modified technique does not require anticoagulation and has demonstrated an improvement in long-term SVC patency. Nevertheless, it can be considered an expensive procedure. Moreover, since the thoracic aortic homograft utilised is biological tissue, only long-term follow-up will determine whether calcification and graft degeneration is an issue. Conclusion: It can be concluded that the modified Warden procedure is a safe and effective method to reconstruct the systemic venous drainage into the right atrium when a direct anastomosis under tension might be prone to re-stenosis.
The authors performed a detailed retrospective analysis of diabetic patients undergoing isolated coronary artery bypass graft surgery (CABG) aiming to investigate the association of the preoperative Glycosylated hemoglobin with occurance of postoperative atrial fibrillation. Altough statistical analysis showed a weak relationship between HbA1c values of 9.06% or above and PoAF, they concluded that serum level of HbA1c could not be used as a predictor for the development of PoAF. But there are many questions to be asked and answers to be found.
The management of patients with transposition complex in combination with an interrupted aortic arch (IAA) presents a technical challenge to the surgeon to decide which is the best approach to correct both defects. This is a rare disorder and with significant variation in anatomic arrangements deciding on the ideal surgical repair. Over time a single-stage approach to repair has become standard.
Kawasaki Disease (KD) is a systemic vasculitis of small and medium arteries, preferably affecting coronary arteries. It is one of the most frequent causes of acquired heart disease in children. Despite being comprehensively studied, its etiopathogenesis is not totally explained. The surgical procedures usually become necessary during the late follow-up and may be coronary artery bypass grafting, cardiac defibrillator implantation with or without cardiac resynchronization therapy, or cardiac transplantation.
Mitral regurgitation in Barlow disease may still be challenging to be repaired . Most often it involves the posterior leaflet . Many techniques and concepts are currently available ; the main goal being to restore a good surface of coaptation . Basic principles such a thorough analysis is still required whatever the approach to assess excess tissue height , width and prolapse . Nowadays it seems that two different ways of treating mitral prolapse coexist : the non resection one and the resection one .Both will be discussed and analysed . Similarly the use of artificial chordae seem to have a preponderant role to support the free edge and correct a prolapse . Native secondary chord transfer are easy and reliable but seem abandoned by many . Anterior leaflet prolapse is also dealt with and fewer options are available to address this leaflet . Then commissural prolapse is mentioned . It is an important area of the valve which should deserve better treatment than commissuroplasty . Finally a special entity will be described ; mitro annular disjonction . The approach is not or no longer an issue as only good long term results are important in an era where per cutaneous therapy is the only non invasive technique .
TITLE PAGE Title: Letter to the Editor: Early experience of aortic surgery during the COVID-19 pandemic in the United Kingdom: A multicenter studyArticle type: Letter to the editorCorrespondence : 1. Sara AlzagloolContact: +962797244907 Email: Sarah97.email@example.comInstitute: Al-Bashir HospitalAddress: Al Bashir Hospital، Ossamah Ben Zeid St. 261, Amman, JordanCo-authors : 2. Osama Al-JaiuossiContact: +962788003306 Email: Osamaeyad@ymail.comInstitute: Al-Bashir HospitalAddress: Al Bashir Hospital، Ossamah Ben Zeid St. 261, Amman, JordanWords count: 480Conflict of interest: NoneFunding: NoneAcknowledgement: NoneDeclaration: None
Title Page:Title : Letter To the Editor: Outcomes of Preoperative Antiplatelet Therapy in Patients With Acute Type A Aortic DissectionArticle Type : Letter To The EditorCorrespondence : 1. Sandhya KumariContact no: +92-3321346164 Email: firstname.lastname@example.orgInstitute: Ziauddin University KarachiAddress: Bungalow Number 7/2, 26th Street, Tauheed Commercial Area, Phase 5 Defence Karachi.ORCID: 0000-0001-8842-8738Co-Author : 2. Roomi RajaContact No: +92-3342946940 Email: Romirajagoindani@yahoo.comInstitution: Ziauddin University KarachiAddress: Hemilton Courts Block G-1 Flat 408 Near Teen Talwar Clifton KarachiORCID: 0000-0001-9104-3644Word Count : 340Conflict of interest : NoneAcknowledgement : NoneDeclaration : NoneDisclosure : NoneFunding : NoneDear Editor,We have, in recent times, read with great interest the article entitled “ Outcomes of Preoperative Antiplatelet Therapy in Patients With Acute Type A Aortic Dissection” by Xuan Jiang MD et al.1 We highly appreciate the author’s efforts towards this highly sensitive topic and it needs to be applauded by the readers.We acknowledge the primary conclusion of the article that patients receiving antiplatelet therapy before having surgery for acute type A aortic dissection is associated with increased mortality and increased need for blood transfusions. However, some concerns appear, disturbing the validity of the study.Even though the authors have highlighted the use of multiple different antiplatelet drugs before the surgery such as ticagrelor, clopidogrel and aspirin, there remains some factors that made an impact on the findings. Firstly, the authors should have considered the patients who are on Dual antiplatelet therapy because mortality and blood transfusion rate in patients using dual antiplatelet therapy is higher as compared to a single antiplatelet drug user.2 Secondly, the authors should have widened their inclusion criteria and could have included patients with preoperative characteristic such as cardiac tamponade and lower systolic blood pressure, like the study of 2014 included these two as variables and found increased prevalence of mortality associated with these variables.3Thirdly, the authors should have classified the patients using Debakey class 1,2 and Penn class A,B,C classifications. For example, a study in 2019 stated that the patients who experienced major bleeding were associated with Debakey class 1 and higher Penn class.4 Lastly, the authors should have taken into consideration some measures while transferring a patient to the ICU to minimize the mortality rate. For example, a study of 2022 stated that patients on new oral anticoagulants required norepinephrine and other inotropic agents while transferring to ICU as compared to patients taking warfarin (Coumadin).5In last, additional new studies should be conducted on patients receiving antiplatelet therapy before undergoing mitral valve surgery so that incidents leading to mortality goes down and prognosis becomes better.References:1- Jiang X, Khan F, Shi E, Fan R, Qian X, Zhang H, Gu T. Outcomes of preoperativeantiplatelet therapy in patients with acute type A aortic dissection. J Card Surg. 2022Jan;37(1):53-61. doi: 10.1111/jocs.16080. Epub 2021 Oct 17. PMID: 34657299.2- Chemtob RA, Moeller-Soerensen H, Holmvang L, Olsen PS, Ravn HB. OutcomeAfter Surgery for Acute Aortic Dissection: Influence of Preoperative AntiplateletTherapy on Prognosis. J Cardiothorac Vasc Anesth. 2017 Apr;31(2):569-574. doi:10.1053/j.jvca.2016.10.007. Epub 2016 Oct 11. PMID: 28017673.3- Hansson EC, Dellborg M, Lepore V, Jeppsson A. Prevalence, indications andappropriateness of antiplatelet therapy in patients operated for acute aortic dissection:associations with bleeding complications and mortality. Heart. 2013 Jan;99(2):116-21. doi: 10.1136/heartjnl-2012-302717. Epub 2012 Oct 9. PMID: 23048167.4- Hansson EC, Geirsson A, Hjortdal V, Mennander A, Olsson C, Gunn J, et al.Preoperative dual antiplatelet therapy increases bleeding and transfusions but notmortality in acute aortic dissection type a repair [Internet]. OUP Academic. OxfordUniversity Press; 2019: doi: org/10.1093/ejctz/ezy469. Epub 2019 january 16.5- Sromicki J, Van Hemelrijck M, Schmiady MO, Krüger B, Morjan M, Bettex D, VogtPR, Carrel TP, Mestres CA. Prior intake of new oral anticoagulants adversely affectsoutcome following surgery for acute type A aortic dissection. Interact CardiovascThorac Surg. 2022 Jun 15;35(1):ivac037. doi: 10.1093/icvts/ivac037. PMID:35258082; PMCID: PMC9252133.
Over the last few years cardiac changed radically and so has the average age of the heart disease population progressively increased. Mitral valve surgery has a significant margin for progress in conservative vs replacement strategy. Mitral disease due to insufficiency in the elderly population has historically suffered from lower repair rates but deficiency alone should not limit repair operations in a specialized environment ensuring good survival.
Background: The management of aortic arch pathologies represents a great challenge and is associated with high rates of mortality and morbidity. A superior endovascular approach via thoracic endovascular aortic repair (TEVAR) has been introduced to treat arch pathologies with specifically designed endografts. This approach was shown to benefit patients who are deemed ‘high risk’ for undergoing OSR as it is a greatly less invasiveness option and thus, yields lower rates of morbidity and mortality. Aims: This commentary aims to discuss the recent study by Tan et al. which reports original data on the neurological outcomes after endovascular repair of the aortic arch using the RELAY™ Branched device. Methods: We carried out a literature search on multiple electronic databases including PubMed, Ovid, Google Scholar, Scopus and EMBASE in order to collate research evidence on the neurological outcomes of endovascular aortic arch repair with TEVAR. Results: Tan and colleagues showed through their original clinical data that the RELAY™ Branched device has a high rate of technical success and favourable neurological outcomes. There were no reported neurological deficits in patients who received the triple-branched RELAY™ Branched device. Conclusion: The RELAY™ Branched endograft is well-established for candidates for aortic arch endovascular repair with favourable neurological outcomes. Multiple considerations can help control the incidence of stroke following endovascular repair. These include optimization of the supra-aortic vessels’ revascularization, weighting the embolic risk in patients with atheromatous disease, and careful preoperative assessment to select the best candidates for arch endovascular repair
Background: Type A aortic dissection (TAAD) involves a tear in the intimal layer of the thoracic aorta proximal to the left subclavian artery, and hence, carries a high risk of mortality and morbidity and requires urgent intervention. This dissection can extend into the main coronary arteries. Coronary artery involvement in TAAD can either be due to retrograde extension of the dissection flap into the coronaries or compression and/or blockage of these vessels by the dissection flap, possibly causing myocardial ischaemia. Due to the emergent nature of TAAD, coronary involvement is often missed during diagnosis, thereby delaying the required intervention. Aims: The main scope of this review is to summarise the literature on the incidence, mechanism, diagnosis, and treatment of coronary artery involvement in TAAD. Methods: A comprehensive literature search was performed using multiple electronic databases, including PubMed, Ovid, Scopus and Embase, to identify and extract relevant studies. Results: Incidence of coronary artery involvement in TAAD was seldom reported in the literature, however, some studies have described patients diagnosed either preoperatively, intraoperatively following aortic clamping, or even during autopsy. Among the few studies that reported on this matter, the treatment choice for coronary involvement in TAAD was varied, with the majority revascularizing the coronary arteries using coronary artery bypass grafting or direct local repair of the vessels. It is well-established that coronary artery involvement in TAAD adds to the already high mortality and morbidity associated with this disease. Lastly, the right main coronary artery was often more implicated than the left. Conclusion: This review reiterates the significance of an accurate diagnosis and timely and effective interventions to improve prognosis. Finally, further large cohort studies and longer trials are needed to reach a definitive consensus on the best approach for coronary involvement in TAAD.
Despite advances in technologies and clinical experience, conduction disorders, after TAVR or SAVR, represent the weak point of these procedures, requiring permanent pacemaker implantation (PPI) till 37.7% of patients in TAVR recipients. The role of PPI in TAVR and SAVR remains controversial in mid- and long-term outcomes. Indeed, many studies have been published with contradictory results, leaving doubts rather than certainties.
A larger use of mitral valve repair is recommended in case of mitral regurgitation. Anterior leaflet repair is generally more difficult than posterior. Presence of atrial fibrillation or dysfunction of left ventricle appears to be independent preoperative factors of failure in case of involvement of the anterior leaflet. In experienced hands anterior leaflet repair can be effective and safe and should theoretically not limit a conservative technique instead of a replacement. This would therefore lead to being more aggressive in the treatment of this pathological condition in the earlier stages of the disease.
Heart failure and atrial fibrillation are often associated. Both conditions share pathophysiology and risk factor; as an example, atrial fibrillation may be regarded as either the ‘cause’ or the ‘consequence’ of heart failure. If coexistent, they are associated to very poor outcome. With this in mind, finding effective therapy for patients presenting with both heart failure and atrial fibrillation remains of paramount importance. There are also little evidence of the role and benefit of surgical atrial fibrillation ablation concomitant to heart surgery (i.e., coronary or valve surgery).