Abstract in English:

ABSTRACT Introduction: Pediatric cardiac surgery patients need close post-extubation monitoring for ventilation. Non-invasive transcutaneous partial pressure of oxygen (TcPO2) and transcutaneous partial pressure of carbon dioxide (TcPCO2) offer continuous insights and in improving care. Objective: To investigate the correlation of transcutaneous blood gases (TcPO2, TcPCO2) with arterial blood gases i.e. arterial partial pressure of oxygen (PaO2) and arterial partial pressure of carbon dioxide (PaCO2). Methods: We conducted a study on 30 pediatric post-cardiac surgery patients (four months to three years old) who were extubated and exhibited stable hemodynamics (inotropic score ≤ 5), normal sinus rhythm, and no respiratory or heart failure signs. Continuous transcutaneous and intermittent arterial blood gas monitoring started one hour after extubation, with recordings every 30 minutes for four hours. A single observer conducted probe calibration and data recording to minimize variability, while analysis of 240 paired samples included correlation coefficient, linear regression, Bland-Altman analysis, and Mountain plot. Results: The r-value between PaCO2 and TcPCO2 was 0.95, r2-value of 0.9060 (P<0.001). Bland-Altman showed a bias of 2.579, and 95% limits of agreement were -6.4 to 1.3. The r-value between PaO2 and TcPO2 was 0.8942, r2-value of 0.7996 (P<0.001); bias of 20.171 and 95% limit of agreement of -0.5 to 40.9. The Mountain plot revealed a median of 2.57 for PaCO2 vs. TcPCO2 and 20.17 for PaO2 vs. TcPO2. Conclusion: Transcutaneous carbon dioxide values are interchangeable with arterial PaCO2 in our population study, acting as a surrogate in postoperative pediatric cardiac surgery. Confirmation with arterial blood gases is needed if discrepancies occur.

Abstract in English:

ABSTRACT Introduction: Minimally invasive techniques for aortic valve replacement have become increasingly popular. The most common minimally invasive approaches are mini-sternotomy and right anterior mini-thoracotomy. We aimed to review the literature and compare clinical outcomes for these two approaches. Methods: Three databases were assessed. The primary endpoint was perioperative mortality. The secondary endpoints were reoperation for bleeding, stroke, operation duration, intensive care unit length of stay, cardiopulmonary bypass time, cross-clamping time, hospital length of stay, paravalvular leak, renal complications, conversion to full sternotomy, permanent pacemaker implantation, and wound infection. Random effects models were performed. Results: Ten studies were included in the meta-analysis (30,524 patients). There was no difference in perioperative mortality between groups (odds ratio: 0.83; 95% confidence interval 0.57-1.21; P=0.33). In comparison with mini-sternotomy, right anterior mini-thoracotomy showed higher rates of reoperation for bleeding (odds ratio: 0.69; 95% confidence interval 0.50-0.97; P=0.03), lower rates of stroke (odds ratio: 1.27; 95% confidence interval 1.01-1.60; P=0.04), and longer operation duration (standard mean difference: -0.58; 95% confidence interval -1.01 to -0.14; P=0.01). Other secondary endpoints were not statistically significant. Conclusion: The results suggest that both techniques present similar perioperative mortality rates for aortic valve replacement. However, right anterior mini-thoracotomy is associated with higher rates of reoperation for bleeding, lower rates of stroke, and longer operation duration time.

Abstract in English:

ABSTRACT Reentry to the mediastinum when the ascending aorta aneurysm is adherent to the sternum is characterized by high risk of aneurysm rupture during sternum opening. In such cases, often cardiopulmonary bypass via peripheral vessels is instituted, and reentry done in deep hypothermia and circulatory arrest. To reduce both risks of aneurysm rupture during resternotomy and those related to prolonged cardiopulmonary bypass time, we present a surgical approach consisting of a two-stage sternotomy to avoid the risky zone and extra-anatomic epiaortic vessels anastomoses.

Abstract in English:

ABSTRACT Off-pump robotic-assisted minimally invasive direct coronary artery bypass (MIDCAB) achieves revascularization without conventional sternotomy and provides benefit to patients that otherwise may not be ideal surgical candidates. For patients with comorbid atrial fibrillation, left atrial appendage exclusion may reduce stroke risk and is achievable via mini thoracotomy during concomitant MIDCAB. Here, we report four patients who underwent off-pump robotic-assisted MIDCAB and concurrent epicardial left atrial appendage exclusion. Intraoperative transesophageal echocardiography confirmed complete left atrial appendage exclusion in all cases. The concomitant robotic approach proved to be feasible, efficacious, and safe, with no postoperative mortality or stroke events during follow-up.

Abstract in English:

ABSTRACT Persistent left superior vena cava (PLSVC) is a common congenital venous anomaly, usually associated with other congenital heart diseases (12%). Its incidence in the general population is 0.5%. In cardiac surgery patients, it is suspected when using the left subclavian vein or left internal jugular vein for central venous catheter or hemodialysis catheter placement. Transthoracic ultrasound exam is useful in confirming the position of catheters in the venous system by injecting a 5% glucose solution that can be visualized in the right atrium after administration through the catheter. Hemodialysis catheters can be inserted in the PLSVC with good catheter function and no major risk in increase of complications.