Background: The lateral thoracotomy approach for mitral valve surgery was used extensively in the... more Background: The lateral thoracotomy approach for mitral valve surgery was used extensively in the early history of open-heart surgery. Postoperative sternal wound complications are the major problem with sternotomy incision, other disadvantages of median sternotomy is the bad cosmetic appearance of the scar, which is more prone to keloid formation. Aim of the Work: To compare the procedure and early postoperative outcome of the standard sternotomy approach for mitral valve repair surgery versus the video assisted minimally invasive approach through right anterolateral minithoracotomy. Patients and Methods: This study is a randomized, controlled and prospective study. It was conducted on 66 patients suffering from MVD selected randomly (purposive non probability sample) to compare procedure and early outcome of traditional sternotomy versus video assisted minimal invasive technique. Patients were divided into two groups of 33 cases, Group "A" underwent mitral valve surgery through video assisted minimally invasive right anterolateral video-assisted minithoracotomy, while group 'B" underwent mitral valve repair surgery through a conventional median sternotomy from 2020 to August 2021. Results: There was no statistically significant difference as regards the age, sex, NYHA, preoperative echocardiographic findings. Regarding intraoperative comparison, there was highly statistically significant difference in the cross-clamp time, total bypass time and total operative time, this difference may be due to the new experiences in MIMVS. The length of the incision was highly significantly lesser in group "A" than in group "B", There was significant difference in the intensive care parameters. The mechanical ventilation time was shorter in group "A", the blood loss and the blood transfusion required was lesser in group "A". The ICU stay was shorter in group "A". There was significantly less postoperative pain in group (A) than in group (B). Total hospital stay was less in group (A) than in group (B). The complications of group "A" were less serious than those in group "B" but there was no statistical significance. MIMVS was more cost effective than sternotomy group. Conclusion: In patients with mitral valve disease, minimally invasive surgery may be an alternative to conventional mitral valve surgery. Right anterolateral minithoracotomy provides excellent exposure of the mitral valve and offers a better cosmetic lateral scare comparable short-term mortality. Comparable in-hospital morbidity (renal, pulmonary, cardiac complications, and readmissions), Reduced pain perception, transfusions, postoperative blood loss,
Background Ablation devices are being utilized in surgical procedures treating atrial fibrillatio... more Background Ablation devices are being utilized in surgical procedures treating atrial fibrillation. Few studies seek to define a cut-off value for left atrial diameter size beyond which risks of procedure outweigh chance of sinus recovery. This study aims to identify a cut-off value for pre-operative left atrial diameter to assess the efficacy of surgical radio-frequency ablation for treatment of chronic atrial fibrillation in patients undergoing mitral valve surgery. Methods A prospective 6-month follow-up cohort study was done, in which 40 patients were recruited during the period from May 2016 till April 2018. All patients had rheumatic mitral valve disease and permanent atrial fibrillation. Receiver operator characteristic (ROC) curves were used to calculate the area under the curve and cut-off value for left atrial diameter. The efficacy of the overall survival time was estimated using the Kaplan-Meier method. Results Pre-operatively left atrial diameter of > 59 mm was signi...
phy were the main diagnostic tool, however, other diagnostic modalities (C-MRI and C-CT) were hel... more phy were the main diagnostic tool, however, other diagnostic modalities (C-MRI and C-CT) were helpful in offering further diagnostic information and surgical planning. Of the 16 patients, 8 patients were operated on as an urgent or emergency. Among the 16 patients, 9 (56.25%) patients were operated for Myxoma excision. right ventricular sarcoma (1), metastactic leiomyosarcoma (2), metastatic sacral sarcoma (1), and metastatic renal cell carcinoma (2), and Bachets disease (1). There were no in-hospital mortality and all patient had symptomatic improvements. Conclusion: Cardiac tumours still represent a challenging condition. Our review shows that metastatic tumours represent almost 50% of all our cardiac tumours. Appropriate available diagnostic modalities is crucial, as currently prompt complete surgical removal is the only therapeutic & palliative option and offers best chances of survival.
Background: CABG is one of the most common surgical procedures performed worldwide. The operation... more Background: CABG is one of the most common surgical procedures performed worldwide. The operation improves survival as well as the quality of life of patients with coronary artery heart disease. The use of the internal mammary artery (IMA) graft has become increasingly popular in CABG operations due to its demonstrated better long-term patency as compared with that of the saphenous vein graft. Aim of the Work: To determine the clinical outcome of GABG in Egyptian Septuagenarian population and to identify risk factors that may adversely affect morbidities and mortality.
Aortic root abscess complicated by infective endocarditis of a mechanical prosthetic valve is ass... more Aortic root abscess complicated by infective endocarditis of a mechanical prosthetic valve is associated with morbidity and death. We retrospectively report our experience with a valve-sparing technique for managing this condition. From October 2014 through November 2017, 41 patients at our center underwent surgery for aortic root abscess complicated by infective endocarditis of a mechanical prosthetic valve. Twenty (48.7%) met prespecified criteria for use of our valve-sparing technique after careful assessment of the mechanical valve and surrounding tissues. Our technique involved draining the abscess, aggressively débriding all infected and necrotic tissues, and then repairing the resulting defect by suturing a Gelweave patch to the healthy aortic wall and to the cuff of the valve. We successfully preserved the mechanical aortic valve in all 20 patients. Two (10%) died early (≤30 d postoperatively) of low cardiac output syndrome with progressive heart failure, superadded septicem...
Background: Ablation devices are being utilized in surgical procedures treating atrial fibrillati... more Background: Ablation devices are being utilized in surgical procedures treating atrial fibrillation. Few studies seek to define a cut-off value for left atrial diameter size beyond which risks of procedure outweigh chance of sinus recovery. This study aims to identify a cut-off value for pre-operative left atrial diameter to assess the efficacy of surgical radio-frequency ablation for treatment of chronic atrial fibrillation in patients undergoing mitral valve surgery. Methods: A prospective 6-month follow-up cohort study was done, in which 40 patients were recruited during the period from May 2016 till April 2018. All patients had rheumatic mitral valve disease and permanent atrial fibrillation. Receiver operator characteristic (ROC) curves were used to calculate the area under the curve and cut-off value for left atrial diameter. The efficacy of the overall survival time was estimated using the Kaplan‐Meier method. Results: Pre-operatively left atrial diameter of 59 mm was signifi...
phy were the main diagnostic tool, however, other diagnostic modalities (C-MRI and C-CT) were hel... more phy were the main diagnostic tool, however, other diagnostic modalities (C-MRI and C-CT) were helpful in offering further diagnostic information and surgical planning. Of the 16 patients, 8 patients were operated on as an urgent or emergency. Among the 16 patients, 9 (56.25%) patients were operated for Myxoma excision. right ventricular sarcoma (1), metastactic leiomyosarcoma (2), metastatic sacral sarcoma (1), and metastatic renal cell carcinoma (2), and Bachets disease (1). There were no in-hospital mortality and all patient had symptomatic improvements. Conclusion: Cardiac tumours still represent a challenging condition. Our review shows that metastatic tumours represent almost 50% of all our cardiac tumours. Appropriate available diagnostic modalities is crucial, as currently prompt complete surgical removal is the only therapeutic & palliative option and offers best chances of survival.
Background: It remains unclear how cardioplegic arrest affects surgical results after coronary ar... more Background: It remains unclear how cardioplegic arrest affects surgical results after coronary artery bypass grafting. This study compares early outcome after onpump beating-heart coronary revascularization and conventional revascularization in patients with ejection fractions of less than 30%. Methods: From 2005 to 2008, 167 patients with ejection fraction less than 30% underwent CABG. On-pump beating-heart CABG was carried out in 75 patients (group 1) and 92 patients had the conventional technique (group2). Both groups were otherwise similar in their risk factors and the co-morbid conditions. Results: In-hospital mortality was less in the on-pump beating-heart CABG group (4% versus 4.34%). Twelve patients in the conventional CABG group required insertion of intra-aortic balloon pump initiated intraoperatively or postoperatively, whereas only 2 patients required it in the on-pump beating-heart CABG group. The ventilation time in hours was longer in the conventional group (10± 12.3 versus 7.6±11.7). No significant difference was found in morbidity including stroke and renal failure. The incidence of postoperative atrial fibrillation was significantly less in on pump beating group compared to conventional group occurring in 6 versus 21 patients in group 2. The duration of intensive care unit stay and the hospital stay were significantly shorter in the on-pump beating-heart CABG group. Conclusions: On-pump beating-heart CABG can be performed safely in high-risk patients. Use of cardiopulmonary bypass and the elimination of Cardiovascular Cardiovascular The Journal of Egyptian Society Cardiothoracic Surgery • Volume 17, Number (1-2) 5 Cardiovascular cardioplegic arrest may be of most benefit to hemodynamically unstable patients.
Background: The lateral thoracotomy approach for mitral valve surgery was used extensively in the... more Background: The lateral thoracotomy approach for mitral valve surgery was used extensively in the early history of open-heart surgery. Postoperative sternal wound complications are the major problem with sternotomy incision, other disadvantages of median sternotomy is the bad cosmetic appearance of the scar, which is more prone to keloid formation. Aim of the Work: To compare the procedure and early postoperative outcome of the standard sternotomy approach for mitral valve repair surgery versus the video assisted minimally invasive approach through right anterolateral minithoracotomy. Patients and Methods: This study is a randomized, controlled and prospective study. It was conducted on 66 patients suffering from MVD selected randomly (purposive non probability sample) to compare procedure and early outcome of traditional sternotomy versus video assisted minimal invasive technique. Patients were divided into two groups of 33 cases, Group "A" underwent mitral valve surgery through video assisted minimally invasive right anterolateral video-assisted minithoracotomy, while group 'B" underwent mitral valve repair surgery through a conventional median sternotomy from 2020 to August 2021. Results: There was no statistically significant difference as regards the age, sex, NYHA, preoperative echocardiographic findings. Regarding intraoperative comparison, there was highly statistically significant difference in the cross-clamp time, total bypass time and total operative time, this difference may be due to the new experiences in MIMVS. The length of the incision was highly significantly lesser in group "A" than in group "B", There was significant difference in the intensive care parameters. The mechanical ventilation time was shorter in group "A", the blood loss and the blood transfusion required was lesser in group "A". The ICU stay was shorter in group "A". There was significantly less postoperative pain in group (A) than in group (B). Total hospital stay was less in group (A) than in group (B). The complications of group "A" were less serious than those in group "B" but there was no statistical significance. MIMVS was more cost effective than sternotomy group. Conclusion: In patients with mitral valve disease, minimally invasive surgery may be an alternative to conventional mitral valve surgery. Right anterolateral minithoracotomy provides excellent exposure of the mitral valve and offers a better cosmetic lateral scare comparable short-term mortality. Comparable in-hospital morbidity (renal, pulmonary, cardiac complications, and readmissions), Reduced pain perception, transfusions, postoperative blood loss,
Background Ablation devices are being utilized in surgical procedures treating atrial fibrillatio... more Background Ablation devices are being utilized in surgical procedures treating atrial fibrillation. Few studies seek to define a cut-off value for left atrial diameter size beyond which risks of procedure outweigh chance of sinus recovery. This study aims to identify a cut-off value for pre-operative left atrial diameter to assess the efficacy of surgical radio-frequency ablation for treatment of chronic atrial fibrillation in patients undergoing mitral valve surgery. Methods A prospective 6-month follow-up cohort study was done, in which 40 patients were recruited during the period from May 2016 till April 2018. All patients had rheumatic mitral valve disease and permanent atrial fibrillation. Receiver operator characteristic (ROC) curves were used to calculate the area under the curve and cut-off value for left atrial diameter. The efficacy of the overall survival time was estimated using the Kaplan-Meier method. Results Pre-operatively left atrial diameter of > 59 mm was signi...
phy were the main diagnostic tool, however, other diagnostic modalities (C-MRI and C-CT) were hel... more phy were the main diagnostic tool, however, other diagnostic modalities (C-MRI and C-CT) were helpful in offering further diagnostic information and surgical planning. Of the 16 patients, 8 patients were operated on as an urgent or emergency. Among the 16 patients, 9 (56.25%) patients were operated for Myxoma excision. right ventricular sarcoma (1), metastactic leiomyosarcoma (2), metastatic sacral sarcoma (1), and metastatic renal cell carcinoma (2), and Bachets disease (1). There were no in-hospital mortality and all patient had symptomatic improvements. Conclusion: Cardiac tumours still represent a challenging condition. Our review shows that metastatic tumours represent almost 50% of all our cardiac tumours. Appropriate available diagnostic modalities is crucial, as currently prompt complete surgical removal is the only therapeutic & palliative option and offers best chances of survival.
Background: CABG is one of the most common surgical procedures performed worldwide. The operation... more Background: CABG is one of the most common surgical procedures performed worldwide. The operation improves survival as well as the quality of life of patients with coronary artery heart disease. The use of the internal mammary artery (IMA) graft has become increasingly popular in CABG operations due to its demonstrated better long-term patency as compared with that of the saphenous vein graft. Aim of the Work: To determine the clinical outcome of GABG in Egyptian Septuagenarian population and to identify risk factors that may adversely affect morbidities and mortality.
Aortic root abscess complicated by infective endocarditis of a mechanical prosthetic valve is ass... more Aortic root abscess complicated by infective endocarditis of a mechanical prosthetic valve is associated with morbidity and death. We retrospectively report our experience with a valve-sparing technique for managing this condition. From October 2014 through November 2017, 41 patients at our center underwent surgery for aortic root abscess complicated by infective endocarditis of a mechanical prosthetic valve. Twenty (48.7%) met prespecified criteria for use of our valve-sparing technique after careful assessment of the mechanical valve and surrounding tissues. Our technique involved draining the abscess, aggressively débriding all infected and necrotic tissues, and then repairing the resulting defect by suturing a Gelweave patch to the healthy aortic wall and to the cuff of the valve. We successfully preserved the mechanical aortic valve in all 20 patients. Two (10%) died early (≤30 d postoperatively) of low cardiac output syndrome with progressive heart failure, superadded septicem...
Background: Ablation devices are being utilized in surgical procedures treating atrial fibrillati... more Background: Ablation devices are being utilized in surgical procedures treating atrial fibrillation. Few studies seek to define a cut-off value for left atrial diameter size beyond which risks of procedure outweigh chance of sinus recovery. This study aims to identify a cut-off value for pre-operative left atrial diameter to assess the efficacy of surgical radio-frequency ablation for treatment of chronic atrial fibrillation in patients undergoing mitral valve surgery. Methods: A prospective 6-month follow-up cohort study was done, in which 40 patients were recruited during the period from May 2016 till April 2018. All patients had rheumatic mitral valve disease and permanent atrial fibrillation. Receiver operator characteristic (ROC) curves were used to calculate the area under the curve and cut-off value for left atrial diameter. The efficacy of the overall survival time was estimated using the Kaplan‐Meier method. Results: Pre-operatively left atrial diameter of 59 mm was signifi...
phy were the main diagnostic tool, however, other diagnostic modalities (C-MRI and C-CT) were hel... more phy were the main diagnostic tool, however, other diagnostic modalities (C-MRI and C-CT) were helpful in offering further diagnostic information and surgical planning. Of the 16 patients, 8 patients were operated on as an urgent or emergency. Among the 16 patients, 9 (56.25%) patients were operated for Myxoma excision. right ventricular sarcoma (1), metastactic leiomyosarcoma (2), metastatic sacral sarcoma (1), and metastatic renal cell carcinoma (2), and Bachets disease (1). There were no in-hospital mortality and all patient had symptomatic improvements. Conclusion: Cardiac tumours still represent a challenging condition. Our review shows that metastatic tumours represent almost 50% of all our cardiac tumours. Appropriate available diagnostic modalities is crucial, as currently prompt complete surgical removal is the only therapeutic & palliative option and offers best chances of survival.
Background: It remains unclear how cardioplegic arrest affects surgical results after coronary ar... more Background: It remains unclear how cardioplegic arrest affects surgical results after coronary artery bypass grafting. This study compares early outcome after onpump beating-heart coronary revascularization and conventional revascularization in patients with ejection fractions of less than 30%. Methods: From 2005 to 2008, 167 patients with ejection fraction less than 30% underwent CABG. On-pump beating-heart CABG was carried out in 75 patients (group 1) and 92 patients had the conventional technique (group2). Both groups were otherwise similar in their risk factors and the co-morbid conditions. Results: In-hospital mortality was less in the on-pump beating-heart CABG group (4% versus 4.34%). Twelve patients in the conventional CABG group required insertion of intra-aortic balloon pump initiated intraoperatively or postoperatively, whereas only 2 patients required it in the on-pump beating-heart CABG group. The ventilation time in hours was longer in the conventional group (10± 12.3 versus 7.6±11.7). No significant difference was found in morbidity including stroke and renal failure. The incidence of postoperative atrial fibrillation was significantly less in on pump beating group compared to conventional group occurring in 6 versus 21 patients in group 2. The duration of intensive care unit stay and the hospital stay were significantly shorter in the on-pump beating-heart CABG group. Conclusions: On-pump beating-heart CABG can be performed safely in high-risk patients. Use of cardiopulmonary bypass and the elimination of Cardiovascular Cardiovascular The Journal of Egyptian Society Cardiothoracic Surgery • Volume 17, Number (1-2) 5 Cardiovascular cardioplegic arrest may be of most benefit to hemodynamically unstable patients.
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