The Egyptian Cardiothoracic Surgeon

Conventional left atriotomy versus the superior atrial approach for mitral valve replacement

Mon, 01 Sep 2025 00:00:00 +0200

Background: The optimal atrial approach for exposing the mitral valve with optimized patient outcomes is still controversial. This study compared conventional left atriotomy with the superior atrial approach for mitral valve replacement (MVR).

Methods: A randomized clinical trial was conducted on 60 patients who underwent MVR during the period 2022-2024. Patients were randomized into: Group A (n= 30, left atriotomy) and Group B (n=30, superior atrial approach).

Results: The mean age in Group A was 43.17 ± 8.57 years, whereas that in Group B was 47.63 ± 10.35 years (P = 0.07). No significant differences in sex, smoking status or associated comorbidities were noted between the groups. Echocardiographic findings revealed no significant differences in left ventricular functions and dimensions. Preoperative laboratory data revealed no significant differences in hemoglobin levels, platelet counts, or INRs. The total cardiopulmonary bypass time was shorter in Group B than in Group A but did not reach a significant level (P= 0.08). The cross-clamp times were significantly shorter in Group B (64 ± 5.7 min) than in Group A (69 ± 9.5 min) (P = 0.02). There were no differences in the rate of postoperative complications or duration of hospitalization between the groups. Follow-up echocardiographic evaluations revealed no significant difference between Group A and B in regarding ejection fraction (β: -0.003, 95% CI: -0.04-0.03, P = 0.82). Similarly, the left atrial diameter decreased significantly over time (β-0.05, 95% CI: -0.07- -0.03, P < 0.001), with no significant difference between the groups (β: -0.11, 95% CI: -0.29- 0.06, P = 0.21). Changes in left ventricular end-systolic diameter decreased over time (β: -0.05, 95% CI: -0.06- -0.03, P < 0.001), with no significant difference between groups (β: -0.01, 95% CI: -0.21-0.19, P = 0.92).

Conclusions: The superior atrial approach provided comparable clinical and echocardiographic outcomes to those of left atriotomy for MVR, with shorter cross-clamp times. The superior atrial approach is a good alternative to left atriotomy with comparable safety and efficacy profiles.

Negative Pressure Wound Therapy versus Conventional Treatment in Post cardiac Surgery Sternal Wound Infection

Zakaria Elmashtoly, Hatem Aboelazayem, Haytham Yussuf — Mon, 01 Sep 2025 00:00:00 +0200

Background: Deep sternal wound infection (DSWI) remains a severe complication after cardiac surgery, with direct association with increased morbidity and mortality. This study evaluated the efficacy and safety of negative pressure wound therapy (NPWT) compared with conventional treatment in managing DSWI.
Methods: This randomized study included 40 patients with DSWI postcardiac surgery, which were randomly divided into NPWT (n=20) and conventional treatment (n=20) groups. Patients underwent cardiac surgery between 2019 and 2023 in a single tertiary referral center. The outcomes included wound culture clearance, C-reactive protein (CRP) reduction, complications, and hospital stay.
Results: Preoperative and operative data were comparable between both groups. During treatment, NPWT significantly reduced the percentage of positive cultures to 5% compared with 30% in the conventional group (p=0.037). C-reactive protein (CRP) levels decreased significantly in the NPWT group from 210.14 ± 41.03 mg/L to 5.5 ± 6.42 mg/L (p<0.001), whereas the conventional group presented a minimal reduction from 194.28 ± 18.95 mg/L to 176.85 ± 28.19 mg/L (p=0.125). There were notably fewer complications in the NPWT group than in the conventional group, with only 5% experiencing re-infection (p=0.018). The incidence of necrosis was also lower (5% vs. 20%, p=0.151), and the need for reoperation was lower in the NPWT group (5% vs. 20%, p=0.151). The average length of hospital stay was significantly shorter in the NPWT group (20 ± 3 days) than in the conventional group (36 ± 6 days) (p<0.001).

Conclusion: Negative pressure wound therapy is more effective than conventional treatment in managing deep sternal wound infections following cardiac surgery. NPWT significantly reduces infection rates, accelerates recovery, and minimizes complications, leading to shorter hospital stays. This study supports the use of NPWT as a preferable treatment option for DSWI.

Postoperative Arrhythmia after Total Arterial Coronary Artery Bypass Grafting

Mon, 01 Sep 2025 00:00:00 +0200

Background: Atrial fibrillation (AF) is the most prevalent arrhythmia occurring after cardiac surgery. The occurrence of postoperative AF (POAF) significantly affects patient outcomes, leading to increased morbidity, mortality, and hospital readmission rates. The incidence of POAF following total arterial coronary artery bypass grafting remains a subject of ongoing debate. This study seeks to evaluate the occurrence of early postoperative arrhythmias in patients undergoing total arterial revascularization.

Methods: We studied a cohort of 50 patients who underwent total arterial revascularization at the Cardiothoracic Surgery Department of Benha University Hospitals between October 2023 and October 2024. Data were collected preoperatively and postoperatively, encompassing demographic information, laboratory results, and both intraoperative and postoperative parameters.

Results: The average age of the study population was 52.5 years, with a predominance of male patients. The incidence of postoperative arrhythmias was recorded as follows: 6% for self-contained AF, 6% for uncontrolled AF, 2% for ventricular fibrillation, and 4% for premature ventricular contractions. The mean duration of bypass was 154.9 minutes, and the average length of stay in the intensive care unit (ICU) was 2.1 days. Postoperative complications included wound infections in 28% of patients, and the mortality rate was 4%.

Conclusions: Early postoperative arrhythmias pose a significant concern following total arterial revascularization. Identifying and managing risk factors associated with these arrhythmias could enhance patient outcomes, decrease complications, and ultimately contribute to improved survival and quality of life for individuals undergoing cardiac surgery.

Reconstruction of the Pulmonary Trunk With A Homograft In Patients With Previous Tetralogy of Fallot Repair: A Case Report

Mon, 08 Sep 2025 19:14:45 +0200

Background: Tetralogy of Fallot (TOF) is a common congenital heart defect often requiring pulmonary valve replacement due to complications like pulmonary regurgitation. We present a case of a TOF patient with prior valve replacement admitted for prosthetic valve dysfunction.

Case presentation: At Sechenov University, the patient underwent successful reconstruction of the right ventricular outflow tract and pulmonary trunk using cryopreserved homografts. Postoperative recovery was uneventful, with discharge on day 14.

Conclusion: Pulmonary homografts provide favorable outcomes and reduced reinterventions, though degeneration remains a challenge. Future research should focus on factors affecting implant durability, such as age and size, to optimize long-term outcomes.