The Egyptian Cardiothoracic Surgeon

Endoscopic Versus Open Saphenous Vein Harvesting in Coronary Artery Bypass Grafting

2025-05-06T13:13:33+02:00

Background: Endoscopic saphenous vein grafting has been acknowledged as a valuable method for mitigating postoperative wound scarring and associated problems.

Methods: We reviewed 60 patients who underwent coronary artery bypass surgery and had their vein graft harvested by open (OVH A, n = 30) versus endoscopic (EVH, n = 30) technique. Both groups were matched for age and sex. Wound complications were determined by the presence of ecchymosis, hematoma, keloids, dehiscence, infection, and the need for intervention. The time of harvesting was recorded routinely for each patient.

Results: When comparing open and endoscopic techniques for harvesting saphenous veins, ecchymosis was more in EVH, while wound dehiscence was more in the OVH group. Surprisingly, no significant difference between both groups regarding other wound problems, including purulent discharge. On follow-up, both groups did not show any significant difference in terms of readmissions for leg wound complications, need for plastic surgery, cosmetic satisfaction, bleeding, or recurrence of angina.

Conclusion: Endoscopic technique was associated with increased ecchymosis and reduced wound dehiscence incidence.

Tricuspid valve annuloplasty using autologous pericardial strip versus band for treatment of functional tricuspid regurgitation

2025-05-06T13:13:33+02:00

Background: Options of tricuspid annuloplasty (TAP) for treatment of functional tricuspid regurgitation (FTR) include suture, ring, and autologous pericardium. The aim of this study was to evaluate and compare outcomes of TAP using pericardial strip versus band during left-sided heart valve surgery.

Methods: This retrospective study included adult patients who had autologous pericardial annuloplasty for FTR using pericardial strip and rolled pericardial band. The primary end-point was residual TR (moderate or more) during 1-year follow-up.

Results: The study included 80 patients with mean age of 52.06±11.01 years and most of them were female (63.8%). Tricuspid annuloplasty was performed using pericardial strip (n=50) or band (n=30). During follow-up period, there were no re-operation for TR, severe TR, late complications, mortality, and degeneration or retraction of the pericardial patch. The incidence of residual TR was 7.5% postoperatively and 2.5% during follow-up with no significant differences between both techniques of annuloplasty. Pericardial strip showed higher incidence of postoperative mild TR than band. There was no significant differences in postoperative complications and NYHA class. Follow-up TR grade was significantly correlated with preoperative NYHA class, pulmonary artery systolic pressure, left ventricular ejection fraction, and tricuspid annular plane systolic excursion.

Conclusion: Autologous pericardial strip or band for moderate and severe FTR had similar and acceptable rates of residual TR (moderate or more) postoperatively and at 1-year of follow-up, but pericardial band had temporally lower frequency of postoperative mild TR. Further evaluation is recommended.

Ascending Aortic Aneurysm Caused by Takayasu`s Arteritis: A Case Report

2025-05-06T13:13:33+02:00

Takayasu arteritis (TA) is a rare systemic vasculitis primarily affecting large and medium-sized arteries. It predominantly presents in young femalesa and can lead to significant complications, including aortic aneurysms. We present a case of a 42-year-old male with a history of TA and multiple arterial aneurysms, including an ascending aortic aneurysm measuring 5.7 cm. After routine follow-up and imaging revealed the increasing size of the aneurysm, surgical intervention was deemed necessary. The patient underwent successful surgical repair through median sternotomy and aneurysm plication on cardiopulmonary bypass

The influence of side-to-side stapled esophagogastric anastomosis on the postoperative anastomotic complications among patients undergoing esophagectomy

2025-05-06T13:13:33+02:00

Background: Esophageal cancer is among the most challenging tumors facing thoracic surgeons that entails a highly complex surgical procedure carrying a very high rate of morbidity and mortality. Esophagectomy procedure could be completed using several techniques depending on many factors like tumor location and surgeon preference. There are different techniques for anastomosis construction either stapled or hand sewn and there is a big debate about the ideal method for anastomosis regarding the technique and the location of construction. Our study aimed to clarify the feasibility of performing a side to side stapled cervical esophagogastric anastomosis and to study its effect on the short term outcomes after surgery.

Methods: We have conducted a prospective study for 29 consecutive patients diagnosed with esophageal carcinoma and who received esophagectomy as a curative treatment starting from January 2020 to January 2024. The study was held in Alexandria Main University Hospital.

Results: The mean age for our study group was 63.34 years ±5.31 years and females represented about 34.5%. Regarding tumor location, 13 patients (44.8%) had lower third esophageal tumor, 9 patients (31%) had middle third neoplasm, and 7 patients (24.1%) had gastroesophageal junction tumor. Regarding the anastomotic technique used, circular stapled anastomosis was done in 21 patients (72.41%). Hand sewn cervical anastomosis was used in 5 patients (17.24%) and side to side stapled cervical anastomosis was used in 3 patients (10.34%). Correlation between type of anastomosis and occurrence of leakage and dysphagia showed that anastomotic leakage has occurred in one patient with circular stapled anastomosis and in 2 patients with hand sewn anastomosis, while the side to side stapled anastomosis was not associated with any cases of leakage. Regarding the dysphagia resulting from anastomotic stricture, the side to side stapled anastomosis was not associated with dysphagia on the follow up period, while dysphagia has occurred in one patient with circular stapled anastomosis and another patient with handsewn anastomosis.

Conclusion: Side to side stapled esophagogastric anastomosis is a feasible technique and it could be associated with reduced incidence of early postoperative anastomotic leakage as well as reduced rates of late postoperative anastomotic stricture and dysphagia.