Asian Cardiovascular and Thoracic Annals

The optimal cerebral protection strategy during complex aortic surgery remains controversial, and various brain monitoring modalities are used to provide different information to improve cerebral protection. This study aims to compare the effect of the change in cerebral oxygen saturation during hypothermic circulatory arrest on the early postoperative neurological outcome in antegrade cerebral perfusion (ACP) versus retrograde cerebral perfusion (RCP) during circulatory arrest in adult aortic surgery using cerebral oximetry.

This was a cross-sectional analytic study that enrolled a total of 84 patients undergoing total circulatory arrest during adult aortic surgery divided into two groups. Group A: 42 cases undergoing selective ACP; Group B: 42 cases undergoing RCP.

Cerebral oxygen saturation before and after circulatory arrest (right and left), cerebral oxygen saturation after cardiopulmonary bypass (right and left) and cross clamp time were significantly lower in Group A than Group B. Cerebral oxygen saturation during circulatory arrest (right and left) and circulatory arrest time were significantly higher in Group A than Group B. Regaining of conscious level time, mechanical ventilation time, neurological dysfunction, other organs dysfunction, and mortality were significantly lower in Group A than Group B.

During hypothermic circulatory arrest in complex aortic surgery in adults, cerebral oxygen saturation was an independent predictor of neurological dysfunction in patients who underwent RCP and in patients who underwent ACP.

Coarctation of the aorta (CoA) is a congenital condition that often requires intervention, especially when associated with other intracardiac abnormalities. Surgical approaches to treat complex CoA and associated defects vary, with no universally accepted standard approach. This study evaluates the outcomes of a single-stage extra-anatomic bypass from the ascending to the descending thoracic aorta, along with simultaneous correction of associated intracardiac abnormalities in adult patients.

We conducted a retrospective analysis of 17 adult patients who underwent a single-stage extra-anatomic bypass for complex CoA repair between January 2014 and December 2023. Patients were treated with an ascending to descending thoracic aorta bypass via a right-sided extra-anatomic approach, with simultaneous correction of associated cardiac defects. The primary outcomes measured were perioperative mortality, haemodynamic improvement, and post-operative complications.

The mean age of patients was 35.9 years. The single-stage repair showed a 94.1% survival rate, with significant haemodynamic improvement indicated by a reduction in blood pressure gradient from 49.7 ± 7.4 mmHg pre-operatively to 11.2 ± 3.9 mmHg post-operatively. There were minimal complications, with no evidence of graft failure, kinking, or cerebrovascular incidents during follow-up. One patient experienced acute kidney injury and early mortality. Follow-up of up to 10 years demonstrated durable results with favourable outcomes.

The single-stage extra-anatomic bypass with simultaneous correction of associated cardiac defects is a safe and effective approach for managing complex CoA in adults.

Malignant pleural effusion is characterized by the presence of malignant cells in the pleural fluid. Malignant cells from pleural lavage performed in patients without a coexistent pleural effusion have been identified as an indicator of micrometastatic disease and are associated with a higher recurrence rate and poorer survival. The aim of this study was to evaluate the efficacy and safety of the short-term postoperative outcomes with patients who underwent awake and intubated video-assisted thoracoscopic surgery (VATS) in the management of recurrent malignant pleural effusion. We hypothesized that nonintubated VATS is as safe and effective as intubated VATS for MPE management.

A case series of 315 consecutive patients from January 2021 to November 2023 with malignant pleural effusion. The patients were randomized into two groups as nonintubated video-assisted thoracoscopic Pleurodesis with sedoanalgesia (nonintubated as group A) and video-assisted thoracoscopic pleurodesis with general anesthesia (intubated as group B).

The study included 315 patients who underwent video-assisted thoracoscopic pleurodesis either intubated or not. The mean average age was noted to be 54.58 ± 7.93. There were 178 cases of male patients (65.5%). Visual analogue score showed a significant difference after procedure 4 h without any difference after 24 h. There was a nonsignificant difference between both groups according to changes in dyspnea score and grades of chest X-ray findings of pleural effusion.

Nonintubated VATS is safe in patients, especially those with comorbidity who couldn’t tolerate general anesthesia. It has also similar reliability compared to VATS performed under general anesthesia.