Notes

Screening process and also surveillance involving venous stenosis in AVG: Is it time in order to think again about our own presumptions?
Cognitive impairment is a common complication after cardiac surgery. It complicates not only the patient's recovery and return to normal life, but also has a negative impact on quality of life.
The aim of this study was to investigate the prevalence of cognitive impairment and its impact of quality of life for patients after cardiac surgery.

Before cardiac surgery, mild cognitive impairment was determined to be 20.8 percent and moderate cognitive impairment was 3.3 percent. After surgery, mild cognitive impairment almost doubled to 46.1 percent and moderate cognitive impairment increased to 4.9 percent. Older age, lower education, smoking, and prolonged hospitalization before surgery impacts cognitive impairment. Postoperative cognitive impairment is influenced by older age, prolonged hospitalization before surgery, prolonged operation, mechanical ventilation, and duration of cardiopulmonary bypass. For patients without cognitive impairment before cardiac surgery, general health assessment improved the most without reduced vitality/viability. For patients whose cognitive impairment significantly improved physical activity, pain sensation, and general health assessment improved slightly.

Preoperative cognitive impairment was determined in 1/4 of our patients. Mild cognitive impairment after surgery was slightly increased. Older age, lower education, and prolonged hospitalization before surgery have an impact on cognitive impairment before and after surgery.
Preoperative cognitive impairment was determined in 1/4 of our patients. Mild cognitive impairment after surgery was slightly increased. Older age, lower education, and prolonged hospitalization before surgery have an impact on cognitive impairment before and after surgery.
Reoperation for isolated tricuspid valve (TV) surgery is considered a high-risk procedure. The optimal surgical approach is controversial. We analyzed our experience with isolated TV redo surgery performed either through thoracoscopic approach (thoracoscopic group), right thoracotomy (thoracotomy group), or median sternotomy (sternotomy group).

We retrospectively analyzed all patients with previous cardiac surgery who underwent redo-TV procedure through thoracoscopic approach (n = 33), right lateral thoracotomy approach (n = 14), or sternotomy (n = 72).

All patients successfully underwent elective surgery, with no intraoperative conversion or death occurring. 69% and 31% of patients received valve replacement and valvuloplasty, respectively. After operation, one patient in the sternotomy group received reoperation for bleeding, while another patient received valve replacement surgery 2 weeks after operation due to heart failure caused by valvuloplasty failure. No obvious complications occurred in the minimally invasive groups. The overall success rate of valve repair during 1-year follow-up was 99.2%.

Minimally invasive, isolated TV surgery as reoperation can be safe and may improve clinical outcome.
Minimally invasive, isolated TV surgery as reoperation can be safe and may improve clinical outcome.Brachial mycotic pseudoaneurysms (BMPA) are a rare complication of infective endocarditis (IE), but potentially could be a limb-threatening condition. We present the case of a 38-year-old male referred to our department, complaining of the sudden onset of a painful pulsatile mass 5 x 10 cm in the right antecubital fossa that slowly progressed over time. Two years before this, he underwent aortic and mitral valve replacement with mechanical prosthetic valves and tricuspid annuloplasty for IE with methicillin-susceptible Staphylococcus aureus after a six-week course of intravenous antibiotherapy with oxacillin. Clinical examination of the right upper limb revealed a pulsatile and compressible mass with a normal temperature and without other clinical signs of inflammation. Pulse of the axillary artery, brachial and radial arteries were palpable. He was diagnosed by Doppler ultrasonography and digital subtraction angiography with BMPA. Furthermore, transesophageal echocardiography (TEE) revealed normal function of the aortic and mitral prosthetic valve with no signs of prosthetic valve endocarditis and no feature of congestive heart failure. Considering these clinical findings, surgical treatment was planned. He underwent re-section of the brachial pseudoaneurysm and arterial reconstruction. One year after the pseudoaneurysm resection, evolution was excellent. This manuscript presents this rare, uncommon complication after IE and also reviews the available surgical management strategies for this pathology.
The aim of our study was to elucidate the association between severity of postoperative hypocalcemia and the prognosis of the patients with 22q11DS.

learn more were collected from 23 children with 22q11DS who underwent cardiac correction surgery. Area under the receiver operating characteristic curve (AUC) and diagnostic odds ratio were calculated to determine the tendency of perioperative mortality rate, according to the minimum levels of serum calcium and the duration of hypocalcemia. A novel risk assessment system for perioperative mortality was established according to these valid parameters.

The death group had lower minimum levels of serum calcium and longer duration of hypocalcemia. The AUC of minimum levels of serum calcium was 0.912 (95% CI 0.753-1; P = .003) and qualified its high accuracy for perioperative mortality. The AUC of duration of hypocalcemia was 0.804 (95% CI 0.561-1; P = .03) and qualified its moderate accuracy. #link# The tendency analyses also indicated the correlation between these two parameters and perioperative mortality. Based on the cut-off values from ROC analysis, a novel risk assessment system for perioperative mortality was established according to these two parameters. The patients with the lowest serum calcium level <0.885 mmol/L or duration of the hypocalcemia > 90.33 hours would be sorted into a high-risk group; others were divided into a low-risk group. The diagnostic odds ratio for this assessment system was 143(95% CI 5.13-3982.52). No significant difference was found with regard to patient age, weight, preoperative serum total calcium, cardiopulmonary bypass (CPB) time, and aortic cross-clamp time between the high- and low-risk groups.

The minimum levels of serum calcium and duration of hypocalcemia were valid predictors for preoperative mortality of 22q11DS patients.
The minimum levels of serum calcium and duration of hypocalcemia were valid predictors for preoperative mortality of 22q11DS patients.
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