Joensengeertsen3783

BACKGROUND Cardiac tamponade with acute type A aortic dissection (AADA) can cause fatal outcomes. We previously reported excellent outcomes using percutaneous pericardial drainage with controlled volumes of aspirated pericardial effusion (controlled pericardial drainage CPD) to stabilize patients with critical cardiac tamponade. This study evaluates the early and late outcomes using this approach. METHODS Between 9/03 and 7/18, 308 patients with AADA were treated surgically, including 76 patients who were presented with cardiac tamponade on arrival at hospital. Forty-nine patients who did not respond to intravenous volume resuscitation underwent CPD in the emergency room, including 14 patients (28.6%) who presented with cardiopulmonary arrest (CPA). After CPD, 39 patients (79.6%) were transferred to the operating room to undergo immediate aortic repair. The remaining 10 patients (20.4%) received medical treatment on arrival, followed by aortic repair within several days. RESULTS In 49 patients, the mean systolic blood pressure before CPD was 64.4 ± 10.3 mmHg. Blood pressure rose significantly in all patients after CPD. The total volume of aspirated pericardial effusion was 46.8 ± 56.2 ml, and 30 of the 49 patients (61%) required only 30ml or less of aspiration to improve their blood pressure. All of the patients underwent successful aortic repair. Early hospital mortality was 16%. However, mortality related to CPD was zero. The mean follow-up periods were 52.9 ± 54.3 months. The cumulative survival rate was 63.4% after five years. CONCLUSIONS Controlled pericardial drainage for critical cardiac tamponade with acute type A aortic dissection produced satisfactory early and late outcomes. BACKGROUND Transcatheter Aortic Valve Replacement (TAVR) has evolved as an alternative therapy to open AVR in most patients with aortic stenosis. Stroke associated with TAVR can be a devastating complication in the short-term, however, little is known regarding mid-term outcomes. METHODS All patients undergoing TAVR from 2011-2018 were included. Modified Rankin Scales (mRS) as a measurement of stroke related disability were extracted for patients who had neurologic deficits. RESULTS A total of 51 (4.3%) patients (out of 1193) developed neurologic events (NE) during study period (32 [2.7%] disabling strokes, 19 [1.6%] non-disabling strokes including 5 [0.4%] transient ischemic attacks). Patients sustaining TAVR NEs were older (85.8±4.2 years vs 81.5±7.9 years,p less then 0.001) and predominantly female (68.6% vs 31.4%,p=0.007) but were comparable in terms of STS predicted score of mortality and vascular access. Patients with NEs were associated with increased short term and mid term mortality (15.7% vs 2.6%, 29.4% vs 13.9% and 47.1% vs 35.7% at 30 days, 1 year and 3 years, respectively). Severity of disability determined by modified Rankin scale (mRS) was a risk factor for 30-day (HR, 5.8; p=0.003), 1-year (HR, 2.1;p less then 0.001) and 3-year (HR, 1.8;p less then 0.001) mortality. Predictors of TAVR NEs were older (OR per year of age, 1.11;p=0.001), low body surface area (OR per m2, 0.22;p=0.050), procedural duration (OR per minute, 1.01;p=0.024) and administration of blood products (OR, 3.23;p=0.002). CONCLUSIONS Stroke increases short term and mid-term mortality following TAVR. Risk prediction for neurologic events in TAVR could aid framework for patient selection, further improving outcomes. BACKGROUND Our objective is to report our outcomes and demonstrate our evolving technique for robotic sleeve resection of the airway, with or without lobectomy, using video vignettes. METHODS We retrospectively reviewed a single surgeon prospective database from October 2010 to October 2019. RESULTS Over 9 years, there were 5,573 operations of which 1951 were planned for a robotic approach. There were 755 robotic lobectomies, 306 robotic segmentectomies, and 23 consecutive patients were scheduled for elective completely portal, robotic sleeve resection. Sleeve lobectomy was performed in 18 patients 10 right upper lobe, 6 left upper lobe, and 2 right lower lobe. Two patients had mainstem bronchus resections and two underwent right bronchus intermedius resections that preserved all of the lung. One patient had a robotic pneumonectomy. There was one conversion to open thoracotomy due to concern for anastomotic tension in a patient who received neoadjuvant therapy. All patients had an R0 resection. In the last 10 operations, we modified our airway anastomosis, using a running self-locking absorbable suture. The median length of stay was 3 days (range 1-11). There were no 30- or 90-day mortalities. Within a median follow-up of 18 months, there were no anastomotic strictures and no recurrent cancers. CONCLUSIONS Our early and midterm results show that a completely portal robotic sleeve resection is safe and oncologically effective. The technical aspects of a robotic sleeve resection of the airway are demonstrated using video vignettes. BACKGROUND Acute pulmonary embolism (PE) is associated with significant mortality. Surgical embolectomy is a viable treatment option; however, it remains controversial due to variable outcomes. This review investigates patient outcomes following surgical embolectomy for acute PE. METHODS Electronic search was performed to identify articles reporting surgical embolectomy for treatment of PE. 32 studies were included comprising 936 patients. Demographic, perioperative, and outcome data were extracted and pooled for systematic review. RESULTS Mean patient age was 56.3 [95% CI 52.5; 60.1] years and 50% [46; 55] were male. 82% had right ventricular dysfunction [62; 93], 80% [67; 89] had unstable hemodynamics, and 9% [5; 16] experienced cardiac arrest. Massive PE and submassive PE were present in 83% of patients [43; 97] and 13% [2; 56], respectively. Before embolectomy, 33% of patients [14; 60] underwent systemic thrombolysis and 14% [8; 24] catheter embolectomy. Preoperatively, 47% of patients were ventilated [26; 70] and 36% had percutaneous cardiopulmonary support [11; 71]. Mean operative time and mean cardiopulmonary bypass time were 170 [101; 239] and 56 [42; 70] minutes, respectively. Intraoperative mortality was 4% [2; 8]. Mean hospital and ICU stay were 10 [6; 14] and 2 [1; 3] days, respectively. AK 7 cost Mean postoperative systolic pulmonary artery pressure (sPAP) was significantly decreased from preoperative (sPAP 57.8 mmHg [53; 62.7]) to postoperative period (sPAP 31.3 mmHg [24.9; 37.8]), p less then 0.01). In-hospital mortality was 16% [12; 21]. Overall survival at five years was 73% [64; 81]. CONCLUSIONS Surgical embolectomy is an acceptable treatment option with favorable outcomes.