The Egyptian Cardiothoracic Surgeon

Role of Dobutamine Stress Echocardiography in Prediction of Reversibility of Moderate Ischemic Mitral Regurgitation In Patients Undergoing CABG

2025-11-01T13:41:22+02:00

Background: Ischemic mitral regurgitation (IMR) is a frequent consequence of ischemic heart disease (IHD) and commonly occurs in patients undergoing coronary artery bypass grafting (CABG). The best approach for managing moderate IMR remains debated, especially concerning the necessity of mitral valve surgery (MVS) alongside CABG. This study evaluates the role of dobutamine stress echocardiography (DSE) in predicting the reversibility of moderate IMR and its effect on surgical outcomes.

Methods: This cross-sectional study included 60 patients with moderate IMR undergoing CABG, with or without MVS, based on DSE findings. Patients were divided into two equal groups: Group A (CABG alone) and Group B (CABG with MVS). Clinical, echocardiographic, and postoperative data were collected, and patients were followed for six months.

Results: No significant difference in short-term survival was observed between the groups. However, the CABG+MVS group showed greater improvement in IMR severity, with 96.6% achieving none-to-mild IMR at follow-up compared to 80% in the CABG-only group (p = 0.04). Additionally, the effective regurgitant orifice area (EROA) was significantly smaller in the CABG+MVS group (5.90 ± 3.63 mm² vs. 20.03 ± 8.41 mm², p < 0.001). Despite these benefits, the incidence of low cardiac output syndrome (LCOS) was higher in the CABG+MVS group (60% vs. 33.3%, p = 0.03).

Conclusion: Combined CABG and MVS significantly improves IMR severity and clinical outcomes in patients with moderate IMR but increase the risk of LCOS. Preoperative DSE is a valuable tool in selecting appropriate candidates for MVS.

Early versus late surgical revascularization after acute myocardial infarction

2025-11-01T13:41:22+02:00

Background: Optimal timing for coronary artery bypass grafting (CABG) after acute myocardial infarction (AMI) remains contentious. Early surgical intervention may minimize myocardial damage but carries increased risks, while delayed surgery allows myocardial stabilization but may lead to recurrent ischemic events.Our objectives is to compare early (0-3 days post-AMI) versus late (4-30 days post-AMI) surgical revascularization outcomes, focusing on mortality and postoperative complications.

Methods: This prospective cohort comparative study was conducted from June 2023 to May 2024 at three centers in Egypt. Sixty patients (mean age 55.67 ± 9.05 years; 85% male) undergoing CABG within 30 days of AMI were enrolled. Patients were divided into two groups based on timing: Early CABG (0–3 days post-AMI, n=30) and Late CABG (4–30 days post-AMI, n=30). Preoperative, intraoperative, and postoperative data were collected. Outcomes were assessed during hospitalization and at follow-up (mean duration 8.1 ± 1.73 months).

Results: Baseline demographic, angiographic, and echocardiographic characteristics were comparable between groups. The early CABG group showed significantly more akinetic/dyskinetic apical wall motion abnormalities (p = 0.001). In-hospital mortality was higher in the early group though without a significant difference (13.3% vs. 3.3%, p = 0.16). Postoperative complications were significantly more frequent in the early CABG group (33.3% vs. 10%, p = 0.02). The durations of ICU stay (3.83±1.36 vs. 2.37±1.71 days, p = 0.001) and total hospital stay (9.33±3.29 vs. 6.83±3.05 days, p = 0.003) were significantly longer in early CABG. Odds of complications were 4.5 times higher in early CABG while mortality odds showed a non-significant trend toward increase.

Conclusion: Early CABG may be associated with increased postoperative complications, necessitating careful patient selection and perioperative management. Delayed CABG allows for myocardial stabilization, potentially reducing perioperative risks.

Pigtail Drainage of Iatrogenic Pneumothorax or Hemothorax: Is a Sufficient Procedure?

2025-11-01T13:41:22+02:00

Background: Pigtail catheters, originally used by cardiologists to drain chronic pericardial effusions, have been adapted for pleural drainage. This study aimed to evaluate the effectiveness of pigtail catheterization as an alternative to chest tube in the management of iatrogenic pneumothorax and hemothorax.

Methods This prospective interventional study included 50 adult patients (>18 years) diagnosed with iatrogenic pneumothorax (Group A, n=25) or iatrogenic hemothorax (Group B, n=25).). All patients underwent clinical evaluation, including history taking, clinical examination, imaging procedures [chest CT and chest x-ray], and laboratory investigations.

Results: Group A had a significantly shorter hospital stay than Group B (P < 0.001). Regarding catheter-related complications, Group B had a significantly higher failure rate (P < 0.001). Univariate analysis revealed that hemothorax, chronic liver disease, central venous line insertion, and true cut biopsy from a central mass were significant risk factors for failure of the pigtail catheter.

Conclusion: Pigtail catheter is more efficient in the management of iatrogenic pneumothorax than hemothorax. It is preferred to initially apply conventional chest tube in the latter to avoid the high failure rate of these small catheters.

The challenging spectrum of mediastinal lesions and their surgical approach: Insights from a single-center experience

2025-11-01T13:41:22+02:00

Background: Mediastinal masses represent a wide variety of pathologies. It occurs in both adults and pediatrics, and many of them are discovered incidentally. The difficult anatomical access for these lesions and their relation to important anatomical structures make diagnosis and treatment a challenge. In this study, we aimed to highlight and describe different pathologies and surgical approaches to these lesions, and to shed light on these important, challenging surgeries and the related morbidity and mortality.

Methods: We retrospectively reviewed the medical records for patients with mediastinal masses under our service between August 2020 and August 2023. Data collected included: age, sex, indication of surgery, approach, role of surgery, definitive pathology, operative time, length of hospital stay, and complications.

Results: A Total of 61 cases were included, 39 females and 22 males, with mean age 31.4 years. The mean operative time was 127.4 minutes (127.4 ± 48.0); mean hospital stay was 3.64 days (3.64 ± 4.89). The complication rate was 21.3% and perioperative mortality was 4.9%.

Conclusion: The wide spectrum of mediastinal pathologies is a challenge every time in decision-making for thoracic surgeons. The choice of surgical approach should be tailored for each case. Open surgery is still the gold standard for large or invasive lesions. Yet minimally invasive video-assisted thoracoscopic and robotic surgery has recently proven safety and efficacy for biopsies and complete resection of mediastinal masses, in selected cases treated by an experienced team.