The Egyptian Cardiothoracic Surgeon

Surgical management of atrial myxoma and study of its inflammatory status: A single center study

2025-07-09T10:37:32+02:00

Background: Cardiac myxomas are rare tumors mostly located in the left atrium, less often in right atrium and occasionally in all heart chambers. The aim of the present study is to report on the early outcomes and expression of inflammatory markers associated with the surgical treatment of myxoma patients between years 2018 up to 2023.

Methods: The study included thirteen patients diagnosed with atrial myxoma. Five patients were retrospective cases under follow up and eight patients underwent prospective surgery. All patients were diagnosed by transthoracic echocardiography, then underwent median sternotomy for complete tumor resection. Left atrial myxoma was found in eleven cases while right atrial myxoma were found in two cases. Blood samples were obtained pre- and post-operatively from the eight prospective cases to determine the protein levels inflammatory markers IL-6 and TNF-α in addition to mRNA levels of IL-6.

Results: Female patients represented 69.23% of total patients. Shortness of breath was involved in 61.53%, palpitation in 15.38% and atrial fibrillation in 15.38%. of patients. Mean tumor size was 3.75±1.6 cm. No recurrence or mortality were recorded and only one case of wound infection was found (7.69%). Biochemical results revealed significant increase (p<0.05) in IL-6 levels pre-operatively (99.25 ± 8.78 pg/mL) compared to post-operatively (41.13 ± 10.40 pg/mL). Moreover, IL-6 gene expression showed down-regulation in post-operative blood samples (p<0.05). In addition, TNF-α levels were significantly increased (p<0.05) pre-operatively (97.5 ± 16.34 pg/mL) compared to post-operatively (42.38 ± 8.03 pg/mL).

Conclusion: Transthoracic echocardiography is the best diagnostic tool for myxoma diagnosis, median sternotomy with complete tumor resection decrease the rate of recurrence and mortality. Moreover, cardiac myxomas are associated with a distinct inflammatory state, evident by increased circulating inflammatory mediators as IL-6 and TNF-α which may act as markers in follow up to avoid recurrence.

Impact of gender on postoperative outcome after posterior chordal preservation during isolated mitral valve replacement: A retrospective propensity score matched study

2025-07-09T10:37:32+02:00

Background: Female patients experience poorer clinical results after mitral valve surgery. Preserving the sub-valvular chordae may lead to lower morbidity and mortality after mitral valve replacement (MVR) for both genders. This study aimed to compare operative mortality and postoperative morbidity following preservation of posterior mitral leaflet during isolated mechanical MVR, between male and female patients.

Methods: This retrospective study involved adult patients of either gender who had primary isolated MVR. The primary end-point of outcome was a combination of negative postoperative results, including operative mortality and complications. The outcomes were compared based on gender before and after adjusting for preoperative factors related to gender using 1:1 propensity score matching.

Results: The initial sample consisted of 380 patients, mostly female (215/380; 56.57%) with an average age of 51.45±10.79 years. Female patients showed higher rates of previous congestive heart failure, NYHA class III/IV, low ejection fraction, pulmonary hypertension, and atrial fibrillation. After surgery, female patients experienced a significant increase in hospital stay (9.30±3.55 vs 8.95±3.27 days, P = 0.02), total postoperative complications (7% vs 2.4%, P = 0.04), and adverse outcome rates (7.9% vs 2.4%, P = 0.02), with no significant difference in hospital mortality (1.4% vs 0.6%, P = 0.63). In the matched group of 330 patients, there were no significant differences in postoperative results (P < 0.05). Female gender associated with significantly higher odds for the composite of adverse outcomes (OR: 3.45, 95%CI: 1.14 -10.47, P = 0.02), which was not seen in the matched group (OR: 2.05, 95%CI: 0.60-6.94, P = 0.24).

Conclusion: Female gender did not influence the rate of operative mortality after posterior chordal preservation during MVR, but female patients experienced higher rate of overall postoperative complications and longer duration of hospital stay than male patients. When adjusting for preoperative risk factors, female gender did not impact postoperative outcomes.

Endoscopic versus Open radial artery harvesting for Coronary Bypass Grafting; one-year patency rates

2025-07-09T10:37:32+02:00

Background: Research is ongoing on the effects of endoscopic radial artery harvesting (ERAH) on clinical outcomes and patient satisfaction. This study evaluated the clinical outcomes, patient satisfaction, and radial artery graft patency of ERAH compared with the open technique (ORAH) for coronary artery bypass grafting (CABG).

Methods: We conducted a randomized controlled clinical trial involving 100 patients who underwent on-pump elective CABG with three or four vessels. Patients were randomly allocated into two groups: the ERAH group consisted of 50 individuals who underwent radial artery harvesting via endoscopy, whereas the ORAH group included 50 patients whose radial arteries were harvested via the conventional open technique. The study outcomes included the length of radial artery harvest, operating time, and postoperative outcomes, including hematoma formation, wound infection, and local neurological issues related to lesions of the dorsal radial nerve.

Results: Hospital stays were significantly shorter in the ERAH group than in the ORAH group (7.06 ± 0.79 days vs. 7.9 ± 0.81 days, P < 0.001). Additionally, peripheral neurological complications were significantly different between the groups, occurring in none of the patients in the ERAH group but in 6 patients (12%) in the ORAH group. Wound healing was also significantly better in the ERAH group than in the ORAH group (100% vs. 88%, P = 0.027), with all patients in the ERAH group experiencing seamless wound healing. In the ORAH group, two patients (4%) had wound infections, and four patients (8%) developed hematomas. Both groups presented similar rates of perioperative ischemia and radial artery graft patency. Patient satisfaction was significantly better in the ERAH group (P<0.001).

Conclusion: After one year, the patency rates of ERAH and ORAH were similar. However, patient satisfaction and wound healing were better in the ERAH group.

Esophageal Complications after Anterior Cervical Spine Fixation

2025-07-09T10:37:32+02:00

Background; Esophageal perforation may occur spontaneously, induced by a foreign body, or caused by direct trauma or iatrogenically. Anterior approach to the cervical spine surgery which was introduced in the late 1950s and extensively used since its description, is considered a known etiology for esophageal injury.

Patients and methods: We retrospectively reviewed cases of esophageal perforation that was encountered in our hospital as primary cases or referred from other hospital in between the years 2008 to 2019. All cases with esophageal injury were included. Any patient whose injury caused by other than spinal fixation was excluded.

Result: Eleven cases were encountered with a different time of presentation after surgery ranging from intraoperative discovery to 7 years post spinal fixation. Presenting symptoms were dysphagia, neck pain, persistent discharge from the cervical wound with or without food particles and odynophagia. Management plans varied from surgical intervention with primary repair, debridement, drainage, to conservative management. PEP repair was attempted in all and done in nine patients. Two patients only were treated conservatively without esophageal repair as the tear was small and in the early postoperative period. Supportive treatment in the form of frequent wound care, broad spectrum IV antibiotics, NPO and adequate feeding via alternative routes were secured as well.

Conclusion: Esophageal injury, although uncommon in anterior spinal approach, still considered a life-threatening complication and need a low threshold of suspicion from the surgeon with prompt and targeted intervention as there is no definite guide-line for the management.