The Egyptian Cardiothoracic Surgeon

Early Results of Coronary Artery Bypass Grafting Surgery with or without Coronary Endarterectomy

Ahmed Emara — 2024-11-01

Background: Managing patients with diffuse coronary artery disease is challenging. The advantages of coronary endarterectomy (CE) combined with coronary artery bypass grafting (CABG) compared to CABG alone are controversial. This study compared short-term outcomes, including ICU and hospital stays, arrhythmias, postoperative myocardial infarction, renal impairment, and hospital mortality, between patients who underwent CABG without and with CE.

Methods: This randomized controlled study included 100 patients who underwent CABG with or without CE. Participants were randomly allocated into two equal groups. Group I (n=50) included patients who underwent CABG alone, and Group II (n=50) included patients who underwent CABG combined with CE.

Results: The right coronary artery was the most common vessel affected by CE (44%), followed by the left anterior descending artery (42%). Low-output syndrome and pleural effusion were more frequently observed in Group II; however, these differences did not reach statistical significance. There was no difference in postoperative complications or ejection fraction between the groups. The ICU stay was significantly longer in Group II (3.02±0.84 vs. 2.58±0.5 days; p=0.007). Additionally, patients in Group II had significantly longer hospital stays (14.48±1.87 vs. 11.98±1.35, p<0.001).

Conclusion: Compared with CABG alone, CABG with CE might not be associated with increased short-term mortality or morbidity. CABG with CE was associated with prolonged hospitalization, necessitating a careful assessment of the benefits versus an extended hospital stay when considering this adjunctive procedure.

Outcome of Pectus Carinatum Treatment with the FMF® Dynamic Compressor System

Abdelhamid Sherif — 2024-11-01

Background: The use of the FMF dynamic compressor system for managing pectus carinatum (PC) has recently gained popularity. However, its efficacy and factors affecting treatment success are under investigated. The objective was to evaluate the outcome of PC treatment using an FMF dynamic compressor system.

Methods: This retrospective cohort study included 56 patients aged 13–17 years diagnosed with PC and managed using compression braces. A custom-made brace was made and applied. Patients were instructed to wear the brace to the greatest extent possible for optimal outcomes. Subsequent visits were scheduled, first every 6-8 weeks and thereafter every 3-4 months, until chest correction was achieved. The study outcomes were treatment success and complications.

Results: 46 (82.14%) had successful treatment. The pressure at initial correction was significantly lower in the successfully treated group than in the unsuccessfully treated group (6.8 ± 3 vs. 9.4 ± 3.84 psi, p=0.022). The successfully treated group had a significantly greater initial pressure of treatment than the unsuccessfully treated group (4.3 ± 1.19 vs. 2.9 ± 1.07 psi, p=0.001). The mean time to correction in the successfully treated group was 4.02 ± 1.72 months. Regarding self-assessment of the chest in the successfully treated patients, there was significant improvement after 6 (5.4 ± 1.47) and 12 months (5.5 ± 1.7) compared to the baseline assessment (2.2 ± 1.22) (p<0.001 for both), with no significant difference between the assessments after 6 and 12 months (p=0.743). Age (β: 0.132; p=0.01), the pressure of initial correction (PIC) (β: -0.214; p= 0.024), and high PIC (β: 2.092; p= 0.001) were significant risk factors for correction time.

Conclusions: A chest wall brace for treating PC with a compressive mechanism to correct this chest wall deformity might be a viable option in children and young adolescents with a high success rate.

Rapid Pleurodesis: Single Agent Single Session Vs. Multiple Sessions Using Multiple Agents in the Treatment of Recurrent Malignant Pleural Effusion

Ibrahim Mohammed Ibrahim Khalil — 2024-11-01

Background: One prevalent, upsetting side effect of several oncological conditions is malignant pleural effusion. Pleurodesis is one of the most effective ways to reduce symptoms, stop recurrence, and enhance quality of life. This prospective study aimed at evaluating the performance of three rapid pleurodesis procedures and determine which modality achieved the most positive results, the fewest problems, and the most cost-efficiency.

Methods: This study included 91 patients with recurrent and rapidly collecting malignant pleural effusion. They were distributed into three groups: Group A (single session, single agent), Group B (single session, combined agents), and Group C (multiple sessions, multiple agents) pleurodesis through a catheter which was closed for 2 hours and then opened to drain. The catheter was then removed, and the patient was discharged to continue outpatient follow-up.

Results: Group A included 28 patients, Group B included 29 patients, and Group C included 34 patients. The most common primary malignancy was breast cancer in Group A (46.4 %), and lung cancer in Group B (48.3%) and Group C (47.1 %). Frequently encountered complications following pleurodesis were fever (7.1%, 10.3% and 11.8 % for group A, B and C respectively); and dyspnea (7.1 % in Group A), (13.8% in Group B), and (8.8% in Group C). Hospital stay was longer in the third group with (p<0.001) without significant difference in the outpatient follow-up for lung inflation and recurrence as in one week was (3.6 % in Group A), (0 % in Group B and Group C), in one month was (10.7 % in Group A), (6.9 % in Group B), and (2.9 % in Group C), in 3 months was (14.3 % in Group A), (17.2 in Group B), and (11.8% in Group C).

Conclusion: Rapid pleurodesis – either with a single agent in a single session, a combined agent in a single session, or multiple sessions using multiple agents – is an effective treatment to avoid the recurrence of malignant pleural effusion with minimal side effects. Since the first protocol is equally successful and requires only a short hospital stay at a moderate cost, we recommend it.