Publications by authors named "Tornike Sologashvili"

28 Publications

  • Page 1 of 1

Double-root inversion for complex malposition of the great arteries with tricuspid valve straddling.

Multimed Man Cardiothorac Surg 2021 03 8;2021. Epub 2021 Mar 8.

University Hospital of Geneva University Hospital of Laussane Switzerland.

Dextro-transposition of the great vessels associated with pulmonary stenosis, double-outlet right ventricle, and straddling of the tricuspid valve is an uncommon condition. Several treatment options are available for this malformation, but most of them are not optimal. For patients with transposition of the great vessels, the gold standard procedure, which is an arterial switch procedure, would usually be performed, whereas for patients with pulmonary stenosis, a Rastelli operation or a Nikaidoh procedure would be proposed. Both of these methods have several advantages and disadvantages. Selected patients can qualify for the double-root rotation procedure, which is limited by the function of the pulmonary and aortic valves, the position of the coronary arteries, and the skill of the surgeon[1]. After a thorough analysis of all the preoperative test results, our patient qualified for a surgical correction of the malformation. Due to preexisting pulmonary regurgitation and severe dilation of the pulmonary root, the patient was not considered a good candidate for the arterial switch operation. Therefore, it was decided that the double-root inversion was the best option. Introduction The double-root inversion gives the patient the possibility of avoiding a reoperation. If the patient were to have the Nikaidoh or the Rastelli procedure, we know that the pulmonary graft would eventually have to be replaced. For this reason, we would like to share our experience with the double-root inversion method.
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http://dx.doi.org/10.1510/mmcts.2021.016DOI Listing
March 2021

"Micro-Bentall" procedure.

Multimed Man Cardiothorac Surg 2020 12 24;2020. Epub 2020 Dec 24.

University Hospital of Geneva University Hospital of Laussane Switzerland.

Truncus arteriosus, an anomaly of the conotruncus, is an extremely rare congenital heart disease that affects 1.19% of all patients with congenital heart diseases.  We present a surgical technique using an 8-mm cryopreserved aortic root homograft in the aortic position and a 12-mm pulmonary valved conduit in the right position that allowed us to correct this rare congenital malformation.  The cryopreserved aortic root homograft was considered a priority option for surgical correction.  The neonatal Bentall (micro-Bentall) procedure is a surgically demanding procedure but can be performed successfully by an experienced surgeon.  If we were performing a non-salvage procedure, we would have chosen a decellularized allograft.
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http://dx.doi.org/10.1510/mmcts.2020.079DOI Listing
December 2020

Cylinder mitral and tricuspid valve replacement in neonates and small children.

Eur J Cardiothorac Surg 2020 11;58(5):964-968

Division of Cardiac Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.

Objectives: Atrioventricular valve replacement in small children is associated with high morbidity and mortality. There are no prostheses available with a diameter ˂15 mm. This study reports our initial experience with a cylinder valve for mitral and tricuspid valve replacement in infants and small children.

Methods: Our cylinder valve was hand-made for patients requiring atrioventricuclar valve replacement with an annulus of <15 mm. A 12-mm Contegra valve was prepared and placed inside a 14-mm Gore-Tex tube graft and sutured on both extremities.

Results: Eight patients were included, with a median age of 6.9 months (range 1 day to 38 months). Four had mitral and 4 had tricuspid valve replacement. All implants were technically successful, with no significant regurgitation, no stenosis and no left ventricular outflow tract obstruction. There were 3 early deaths from low cardiac output, in patients with significant associated lesions (severe neonatal Ebstein's, pulmonary artery-intact ventricular septum, biventricular conversion from Norwood stage 1). Two patients required early reintervention: 1 for balloon dilatation for stenosis and 1 for reoperation for paravalvular leak. During follow-up, 2 patients had mitral valve replacement with a 16-mm mechanical valve at 9 and 20 months from the cylinder valve implantation. The remaining 2 patients are alive and well 2 years and 2 months after the procedure.

Conclusions: Cylinder valve replacement of atrioventricular valves was feasible without any technical issues. It was successful in getting out of a difficult situation and allows for somatic growth and implantation of a reasonably-sized mechanical prosthesis on the annulus.
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http://dx.doi.org/10.1093/ejcts/ezaa196DOI Listing
November 2020

Cardiac Neural Crest Cells: Their Rhombomeric Specification, Migration, and Association with Heart and Great Vessel Anomalies.

Cell Mol Neurobiol 2021 Apr 13;41(3):403-429. Epub 2020 May 13.

Department of Cardiovascular Surgery, University of Ottawa Heart Institute and School of Epidemiology, Ottawa, ON, Canada.

Outflow tract abnormalities are the most frequent congenital heart defects. These are due to the absence or dysfunction of the two main cell types, i.e., neural crest cells and secondary heart field cells that migrate in opposite directions at the same stage of development. These cells directly govern aortic arch patterning and development, ascending aorta dilatation, semi-valvular and coronary artery development, aortopulmonary septation abnormalities, persistence of the ductus arteriosus, trunk and proximal pulmonary arteries, sub-valvular conal ventricular septal/rotational defects, and non-compaction of the left ventricle. In some cases, depending on the functional defects of these cells, additional malformations are found in the expected spatial migratory area of the cells, namely in the pharyngeal arch derivatives and cervico-facial structures. Associated non-cardiovascular anomalies are often underestimated, since the multipotency and functional alteration of these cells can result in the modification of multiple neural, epidermal, and cervical structures at different levels. In most cases, patients do not display the full phenotype of abnormalities, but congenital cardiac defects involving the ventricular outflow tract, ascending aorta, aortic arch and supra-aortic trunks should be considered as markers for possible impaired function of these cells. Neural crest cells should not be considered as a unique cell population but on the basis of their cervical rhombomere origins R3-R5 or R6-R7-R8 and specific migration patterns: R3-R4 towards arch II, R5-R6 arch III and R7-R8 arch IV and VI. A better understanding of their development may lead to the discovery of unknown associated abnormalities, thereby enabling potential improvements to be made to the therapeutic approach.
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http://dx.doi.org/10.1007/s10571-020-00863-wDOI Listing
April 2021

Non-visible scar surgery: Right axillary thoracotomy approach for partial atrioventricular canal repair.

Multimed Man Cardiothorac Surg 2019 Dec 18;2019. Epub 2019 Dec 18.

University Hospital Lausanne - Switzerland University Hospital Geneva - Switzerland.

As the outcomes of the repair of congenital heart defects have improved, minimizing the long-term morbidity associated with these repairs has become more important. Avoiding a midline incision and hiding the incision in the axilla allows a virtual "non-visible scar" repair, which can be beneficial for avoiding future psychological morbidity. In this tutorial, we present our technique for right axillary incision for the repair of a partial common atrioventricular defect.
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http://dx.doi.org/10.1510/mmcts.2019.030DOI Listing
December 2019

Pediatric Orthotopic Heart Transplantation.

Multimed Man Cardiothorac Surg 2019 Nov 11;2019. Epub 2019 Nov 11.

University Hospital Lausanne - Switzerland University Hospital Geneva - Switzerland.

Since the first pediatric orthotopic heart transplant was performed by Dr Adrian Krantowicz in 1967, just days after the first ever human transplant by Dr Christiaan Barnard, the technique for orthotopic heart transplantation has evolved from biatrial anastomosis to separate caval anastomoses, leaving the right atrium intact. In this video tutorial, we present our technique for standard orthotopic heart transplantation in children.
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http://dx.doi.org/10.1510/mmcts.2019.038DOI Listing
November 2019

An Innovative Rescue Surgical Procedure for Early Onset Hepatic Venous Outflow Obstruction After Pediatric Living Donor Liver Transplantation.

Liver Transpl 2019 12 20;25(12):1852-1853. Epub 2019 Oct 20.

Division of Cardiovascular Surgery, University Hospitals of Geneva, Geneva, Switzerland.

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http://dx.doi.org/10.1002/lt.25642DOI Listing
December 2019

Glucose-insulin-potassium improves left ventricular performances after aortic valve replacement: a secondary analysis of a randomized controlled trial.

BMC Anesthesiol 2019 09 6;19(1):175. Epub 2019 Sep 6.

Department of Anesthesiology, Pharmacology and Intensive Care, University Hospital of Geneva, CH-1211, Geneva, Switzerland.

Background: Patients with left ventricular (LV) hypertrophy may suffer ischemia-reperfusion injuries at the time of cardiac surgery with impairment in left ventricular function. Using transesophageal echocardiography (TEE), we evaluated the impact of glucose-insulin potassium (GIK) on LV performances in patients undergoing valve replacement for aortic stenosis.

Methods: In this secondary analysis of a double-blind randomized trial, moderate-to-high risk patients were assigned to receive GIK (20 IU insulin with 10 mEq KCL in 50 ml glucose 40%) or saline over 60 min upon anesthetic induction. The primary outcomes were the early changes in 2-and 3-dimensional left ventricular ejection fraction (2D and 3D-LVEF), peak global longitudinal strain (PGLS) and transmitral flow propagation velocity (Vp).

Results: At the end of GIK infusion, LV-FAC and 2D- and 3D-LVEF were unchanged whereas Vp (mean difference [MD + 7.9%, 95% confidence interval [CI] 3.2 to 12.5%; P <  0.001) increased compared with baseline values. After Placebo infusion, there was a decrease in LV-FAC (MD -2.9%, 95%CI - 4.8 to - 1.0%), 2D-LVEF (MD -2.0%, 95%CI - 2.8 to - 1.3%, 3D-LVEF (MD -3.0%, 95%CI - 4.0 to - 2.0%) and Vp (MD - 4.5 cm/s, 95%CI - 5.6 to - 3.3 cm/s). After cardiopulmonary bypass, GIK pretreatment was associated with preserved 2D and 3D-LVEF (+ 0.4%, 95% 95%CI - 0.8 to 1.7% and + 0.4%, 95%CI - 1.3 to 2.0%), and PGLS (- 0.9, 95%CI - 1.6 to - 0.2) as well as higher Vp (+ 5.1 cm/s, 95%CI 2.9 to 7.3), compared with baseline. In contrast, in the Placebo group, 2D-LVEF (- 2.2%, 95%CI - 3.4 to - 1.0), 3D-LVEF (- 6.0%, 95%CI - 7.8 to - 4.2), and Vp (- 7.6 cm/s, 95%CI - 9.4 to - 5.9), all decreased after bypass.

Conclusions: Administration of GIK before aortic cross-clamping resulted in better preservation of systolic and diastolic ventricular function in patients with LV hypertrophy undergoing aortic valve replacement.

Trial Registration: ClinicalTrials.gov: NCT00788242 , registered on November 10, 2008.
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http://dx.doi.org/10.1186/s12871-019-0845-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6731577PMC
September 2019

Effect of implantation site on outcome of tissue-engineered vascular grafts.

Eur J Pharm Biopharm 2019 Jun 17;139:272-278. Epub 2019 Apr 17.

School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, 1211 Geneva, Switzerland.

Objective: Vascular prostheses for small caliber bypass grafts in cardiac and vascular diseases or for access surgery are still missing. Poly (Ɛ-caprolactone) (PCL) has been previously investigated by our group and showed good biocompatibility and mechanical properties in vitro and rapid endothelialisation, cellular infiltration and vascularisation in vivo yielding optimal patency in the abdominal aortic position. The aim of the present study is to evaluate our PCL graft in the carotid position and to compare its outcome to the grafts implanted in the abdominal aortic position.

Methods: PCL grafts (1 mm ID/10 mm long) were implanted into the left common carotid artery in 20 Sprague-Dawley rats and compared to our previously published series of abdominal aortic implants. The animals were followed up to 3, 6, 12 and 24 weeks. At each time point, in vivo compliance, angiography and histological examination with morphology were performed.

Results: PCL grafts showed good mechanical properties and ease of handling. The average graft compliance was 14.5 ± 1.7%/ mmHg compared to 7.8 ± 0.9% for the abdominal position and 45.1 ± 3.2%/ mmHg for the native carotid artery. The overall patency for the carotid position was 65% as compared to 100% in the abdominal position. Complete endothelialisation was achieved at 3 weeks and cell invasion was more rapid than in the aortic position. In contrast, intimal hyperplasia (IH) and vascular density were less pronounced than in the aortic position.

Conclusion: Our PCL grafts in the carotid position were well endothelialised with early cellular infiltration, higher compliance, lower IH and calcification compared to the similar grafts implanted in the aortic position. However, there was a higher occlusion rate compared to our abdominal aorta series. Anatomical position, compliance mismatch, flow conditions may answer the difference in patency seen.
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http://dx.doi.org/10.1016/j.ejpb.2019.04.012DOI Listing
June 2019

Pretreatment with glucose-insulin-potassium improves ventricular performances after coronary artery bypass surgery: a randomized controlled trial.

J Clin Monit Comput 2020 Feb 20;34(1):29-40. Epub 2019 Feb 20.

Department of Anaesthesiology, Pharmacology and Intensive Care, University Hospital of Geneva, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva, Switzerland.

Heart failure is the main cause of poor outcome following open heart surgery and experimental studies have demonstrated that glucose-insulin-potassium (GIK) infusion exerts cardioprotective effects by reducing myocardial ischemia-reperfusion injuries. This randomized controlled trial was designed to assess the effects of GIK on left ventricular function in moderate-to-high risk patients undergoing on-pump isolated coronary artery bypass surgery (CABGS), or combined with aortic valve replacement. The primary outcomes were the effects of GIK on two- and three-dimensional left ventricular ejection fraction (2D and 3D-LVEF), and on transmitral flow propagation velocity (Vp), that occurred between the pre- and post-CPB periods. GIK administration was associated with favorable interaction effects (p < 0.001) on 2D-LVEF, 3D-LVEF and Vp changes over the study periods. In GIK pretreated patients (N = 54), 2-D and 3D-LVEF and Vp increased slightly during surgery (mean difference [MD] + 3.5%, 95% confidence interval [95% CI] - 0.2 to 7.1%, MD + 4.0%, 95% CI 0.6-7.4%, and MD + 22.2%, 95% CI 16.0-28.4%, respectively). In contrast, in the Placebo group (N = 46), 2D-and 3D-LVEF, as well as Vp all decreased after CPB (MD - 7.5% [- 11.6 to - 3.4%], MD - 12.0% [- 15.2 to - 8.8%] and MD - 21.3% [- 25.7 to - 16.9%], respectively). In conclusion, the administration of GIK resulted in better preservation of systolic and diastolic ventricular function in the early period following weaning from CPB.
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http://dx.doi.org/10.1007/s10877-019-00280-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7223403PMC
February 2020

A Case of Persistence of Normal Tissue Oxygenation Monitored by Near-Infrared Spectroscopy (NIRS) Values Despite Prolonged Perioperative Cardiac Arrest.

Am J Case Rep 2019 Jan 5;20:21-25. Epub 2019 Jan 5.

Department of Anesthesiology, University Hospitals of Geneva, Geneva, Switzerland.

BACKGROUND Patients undergoing cardiac surgery are at risk of adverse perioperative neurological complications. Cerebral oximetry monitoring is increasingly used in these patients to detect intraoperative cerebral hypoxia or ischemic events. Near-infrared spectroscopy (NIRS) uses the near-infrared region of the electromagnetic spectrum for oximetry imaging. A case is reported of the persistence of normal tissue oxygenation monitored by NIRS values despite a prolonged perioperative cardiac arrest. CASE REPORT A 65-year-old man was admitted to the Emergency Department with dysarthria, left facial ptosis, left hemiplegia, and arterial hypotension of 75/50 mmHg. Computed tomography (CT) angiography showed a Stanford type A aortic dissection extending to the right common carotid artery. Shortly after arrival in the operating room, his hemodynamic condition rapidly deteriorated resulting in cardiac arrest. Despite the rapid onset of extracorporeal circulation, adequate systemic blood flow could not be restored. Cerebral NIRS values remained within the normal range (70-80%) from the start of emergency resuscitation, during a prolonged period of extremely low global blood perfusion values, and until all resuscitation ceased. CONCLUSIONS Cerebral oximetry values reflect a balance between cerebral oxygen delivery and consumption. This case demonstrated the persistence of normal tissue oxygenation monitored by NIRS values despite a prolonged perioperative cardiac arrest.
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http://dx.doi.org/10.12659/AJCR.911399DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6330994PMC
January 2019

Muscle-sparing extrapleural repair of neonatal aortic coarctation.

Multimed Man Cardiothorac Surg 2018 11 7;2018. Epub 2018 Nov 7.

Cardiac Surgery Centre Hospitalier Universitaire Vaudois Lausanne, Switzerland.

The goal of surgical treatment of aortic coarctation is to relieve the pressure gradient on the aorta and to allow for subsequent growth of the repaired aorta. In this regard, coarctation resection and extended end-to-end anastomosis has become the surgical gold standard. Early and long-term results have been reported to be excellent. In this tutorial, we present our technique for correction of aortic coarctation using a muscle-sparing, extrapleural approach.
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http://dx.doi.org/10.1510/mmcts.2018.057DOI Listing
November 2018

A giant coronary artery aneurysm associated with multiple peripheral arterial aneurysms and an abdominal aortic aneurysm.

Eur J Cardiothorac Surg 2018 09;54(3):598-600

Department of Cardiovascular Surgery, Geneva University Hospital, Geneva, Switzerland.

We report a rare association of a giant aneurysm of the left circumflex coronary artery with multiple peripheral arterial aneurysms and an abdominal aortic aneurysm in a 70-year-old patient. The exclusion of the giant circumflex artery aneurysm was performed successfully by proximal and distal ligation of all branches and bypass surgery using saphenous grafts to vascularize the distal circumflex artery and the marginal branch.
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http://dx.doi.org/10.1093/ejcts/ezy053DOI Listing
September 2018

Rotation of the outflow tracts for complex transposition of the great arteries.

Multimed Man Cardiothorac Surg 2018 07 3;2018. Epub 2018 Jul 3.

University Hospital Lausanne - Switzerland University Hospital Geneva - Switzerland.

Selecting the optimal treatment for transposition of the great arteries with pulmonary stenosis is a challenge. The Rastelli procedure has long been the method of choice, but it carries the risk of subaortic obstruction. The dysplastic pulmonary valve, which cannot function under systemic pressure, can sometimes be recycled in the pulmonary position.  "En bloc" rotation of the outflow tracts has been proposed for treatment of complex transposition of the great arteries and is demonstrated in the following videos. It is a technically demanding procedure and in this tutorial we provide a step-by-step presentation of its technique and the surgical options.
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http://dx.doi.org/10.1510/mmcts.2018.036DOI Listing
July 2018

Two-stage arterial switch for late-presenting transposition of the great arteries.

Interact Cardiovasc Thorac Surg 2018 10;27(4):581-585

Department of Cardiac Surgery, Geneva University Hospitals, Geneva, Switzerland.

Objectives: Ventricular retraining and arterial switch have been described in late-presenting transposition of the great arteries (TGA) in older infants who were unable to undergo neonatal arterial switch operation (ASO) and late survivors of atrial switch with systemic right ventricular dysfunction. There are little data available on patients presenting between these 2 groups. This study aims to review the early and mid-term outcomes of the management of late-presenting TGA with an unprepared left ventricle (LV) by a 2-stage arterial switch.

Methods: The demographic, procedural and outcome data were obtained for all children who underwent LV retraining for late-presenting TGA between 2005 and 2017 at our institution. The primary outcomes were early mortality and extracorporeal membrane oxygenation (ECMO) after arterial switch.

Results: Twenty patients were included during the study period, with a median age of 12 months (range 6 weeks-3.3 years). The median time of LV retraining was 48 (range 8-170) days. Indexed LV mass increased from 34 ± 19 g/m2 before LV retraining to 106 ± 85 g/m2 before arterial switch. There was 1 death (5%) after LV retraining. Three patients required ECMO support after arterial switch (15%) despite retraining. During follow-up, there was 1 late death, no late reinterventions or reoperations, and all surviving patients had normal or near-normal LV function at late follow-up.

Conclusions: LV retraining resulted in an increase in LV mass and enabled a 2-stage arterial switch to be carried out with acceptable early and mid-term outcomes. Two-stage arterial switch is a reasonable option for late-presenting TGA. A long-term follow-up is required to assess late LV function after preparation.
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http://dx.doi.org/10.1093/icvts/ivy093DOI Listing
October 2018

The place of the Ozaki procedure in the treatment of aortic valve disease.

Swiss Med Wkly 2018 26;148:w14612. Epub 2018 Apr 26.

Centre universitaire romand de cardiologie et chirurgie cardiaque pédiatrique, Centre Hospitalier Universitaire Vaudois, Hôpitaux Universitaires de Genève, Lausanne, Switzerland.

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http://dx.doi.org/10.4414/smw.2018.14612DOI Listing
October 2018

Rotation of the outflow tracts.

Interact Cardiovasc Thorac Surg 2018 09;27(3):463-464

Centre Universitaire Romand de Chirurgie Cardiaque Pédiatrique et Cardiologie Pédiatrique, Geneva, Switzerland.

The optimal treatment for transposition of the great arteries with stenosis along the pulmonary tract has always been a challenge. En bloc rotation of the truncus arteriosus has been proposed as an alternative method in this group of patients. We report a truncus turnover in a 3-month-old, 3.4 kg infant.
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http://dx.doi.org/10.1093/icvts/ivy087DOI Listing
September 2018

Myocardial Protection by Glucose-Insulin-Potassium in Moderate- to High-Risk Patients Undergoing Elective On-Pump Cardiac Surgery: A Randomized Controlled Trial.

Anesth Analg 2018 04;126(4):1133-1141

From the Department of Anesthesiology, Pharmacology and Intensive Care.

Background: Low cardiac output syndrome is a main cause of death after cardiac surgery. We sought to assess the impact of glucose-insulin-potassium (GIK) to enhance myocardial protection in moderate- to high-risk patients undergoing on-pump heart surgery.

Methods: A randomized controlled trial was performed in adult patients (Bernstein-Parsonnet score >7) scheduled for elective aortic valve replacement and/or coronary artery bypass surgery. Patients were randomized to GIK (20 IU of insulin, 10 mEq of potassium chloride in 50 mL of glucose 40%) or saline infusion given over 60 minutes on anesthetic induction. The primary end point was postcardiotomy ventricular dysfunction (PCVD), defined as new/worsening left ventricular dysfunction requiring inotropic support (≥120 minutes). Secondary end points were the intraoperative changes in left ventricular function as assessed by transoesophageal echocardiography, postoperative troponin levels, cardiovascular and respiratory complications, and intensive care unit and hospital length of stay.

Results: From 224 randomized patients, 222 were analyzed (112 and 110 in the placebo and GIK groups, respectively). GIK pretreatment was associated with a reduced occurrence of PCVD (risk ratio [RR], 0.41; 95% confidence interval [CI], 0.25-0.66). In GIK-treated patients, the left systolic ventricular function was better preserved after weaning from bypass, plasma troponin levels were lower on the first postoperative day (2.9 ng·mL(-) [interquartile range {IQR}, 1.5-6.6] vs 4.3 ng·mL(-) [IQR, 2.4-8.2]), and cardiovascular (RR, 0.69; 95% CI, 0.50-0.89) and respiratory complications (RR, 0.5; 95% CI, 0.38-0.74) were reduced, along with a shorter length of stay in intensive care unit (3 days [IQR, 2-4] vs 3.5 days [IQR, 2-7]) and in hospital (14 days [IQR, 11-18.5] vs 16 days [IQR, 12.5-23.5]), compared with placebo-treated patients.

Conclusions: GIK pretreatment was shown to attenuate PCVD and to improve clinical outcome in moderate- to high-risk patients undergoing on-pump cardiac surgery.
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http://dx.doi.org/10.1213/ANE.0000000000002777DOI Listing
April 2018

A safe and reproducible method to correct a d-transposition of the great arteries with the usual (type A) coronary artery pattern.

Multimed Man Cardiothorac Surg 2017 Sep 11;2017. Epub 2017 Sep 11.

CURCCCP Centre Universitaire Romand de Cardiologie Chirurgie Cardiaque Pédiatrique Universities of Lausanne and Geneva Rue du Bugnon 46, CH-1011 Lausanne Switzerland.

The success of the arterial switch operation mostly depends on the proper relocation of the coronary arteries. This involves more than the simple suturing of the coronary cuff to the neo-aortic root, it also involves the preparation of the landing zone and the correct mobilisation of the primary coronary branches. In this tutorial, we present our technique for correction of a dextro-transposition of the great arteries with a normal, type A, coronary artery pattern.
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http://dx.doi.org/10.1510/mmcts.2017.013DOI Listing
September 2017

Impact of intrathecal morphine analgesia on the incidence of pulmonary complications after cardiac surgery: a single center propensity-matched cohort study.

BMC Anesthesiol 2017 Aug 22;17(1):109. Epub 2017 Aug 22.

Department of Anesthesiology, Pharmacology and Intensive Care, University Hospital of Geneva, Rue Gabrielle-Perret-Gentil 4, -1211, Geneva, CH, Switzerland.

Background: Acute pain and systemic opioids may both negatively impact respiratory function after cardiac surgery. This study analyzes the local practice of using intrathecal morphine analgesia (ITMA) with minimal parenteral opioid administration in cardiac surgery, specifically the impact on postoperative pulmonary complications (PPCs).

Methods: Data from adult patients who underwent elective cardiac surgery between January 2002, and December 2013 in a single center were analyzed. Propensity scores estimating the likelihood of receiving ITMA were used to match (1:1) patients with ITMA and patients with intravenous analgesia (IVA). Primary outcome was PPCs, a composite endpoint including pneumonia, adult respiratory distress syndrome, and any type of acute respiratory failure. Secondary outcomes were in-hospital mortality, cardiovascular complications, and length of stay in the intensive care unit (ICU) and hospital.

Results: From a total of 1'543 patients, 920 were treated with ITMA and 623 with IVA. No adverse event consequent to the spinal puncture was reported. Propensity score matching created 557 balanced pairs. The occurrence of PPCs in patients with ITMA was 8.1% vs. 12.8% in patients with IVA (odds ratio, 0.6; 95% CI, 0.40-0.89; p = 0.012). Fewer patients with ITMA had a prolonged stay in the ICU (> 4 days; 16.5% vs. 21.2%, p = 0.047) or in the hospital (> 15 days; 25.5% vs. 31.8%. p = 0.024). In-hospital mortality and cardiovascular complications did not differ significantly between the two groups.

Conclusion: In this study involving cardiac surgical patients, ITMA was safely applied and was associated with fewer PPCs.
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http://dx.doi.org/10.1186/s12871-017-0398-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5567923PMC
August 2017

Risk factors of postcardiotomy ventricular dysfunction in moderate-to-high risk patients undergoing open-heart surgery.

Ann Card Anaesth 2017 Jul-Sep;20(3):287-296

Department of Anaesthesiology, Pharmacology and Intensive Care, University Hospital of Geneva; Faculty of Medicine, University of Geneva, Geneva, Switzerland.

Introduction: Ventricular dysfunction requiring inotropic support frequently occurs after cardiac surgery, and the associated low cardiac output syndrome largely contributes to postoperative death. We aimed to study the incidence and potential risk factors of postcardiotomy ventricular dysfunction (PCVD) in moderate-to-high risk patients scheduled for open-heart surgery.

Methods: Over a 5-year period, we prospectively enrolled 295 consecutive patients undergoing valve replacement for severe aortic stenosis or coronary artery bypass surgery who presented with Bernstein-Parsonnet scores >7. The primary outcome was the occurrence of PCVD as defined by the need for sustained inotropic drug support and by transesophageal echography. The secondary outcomes included in-hospital mortality and the incidence of any major adverse events as well as Intensive Care Unit (ICU) and hospital length of stay.

Results: The incidence of PCVD was 28.4%. Patients with PCVD experienced higher in-hospital mortality (12.6% vs. 0.6% in patients without PCVD) with a higher incidence of cardiopulmonary and renal complications as well as a prolonged stay in ICU (median + 2 days). Myocardial infarct occurred more frequently in patients with PCVD than in those without PCVD (19 [30.2%] vs. 12 [7.6%]). By logistic regression analysis, we identified four independent predictors of PCVD: left ventricular ejection fraction <40% (odds ratio [OR] = 6.36; 95% confidence interval [CI], 2.59-15.60), age older than 75 years (OR = 3.35; 95% CI, 1.64-6.81), prolonged aortic clamping time (OR = 3.72; 95% CI, 1.66-8.36), and perioperative bleeding (OR = 2.33; 95% CI, 1.01-5.41). The infusion of glucose-insulin-potassium was associated with lower risk of PCVD (OR = 0.14; 95% CI, 0.06-0.33).

Conclusions: This cohort study indicates that age, preoperative ventricular function, myocardial ischemic time, and perioperative bleeding are predictors of PCVD which is associated with poor clinical outcome.
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http://dx.doi.org/10.4103/aca.ACA_60_17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5535568PMC
May 2018

Posterior wall left ventricular aneurysm repair.

Multimed Man Cardiothorac Surg 2017 04 26;2017. Epub 2017 Apr 26.

Posterior wall aneurysms are a relatively rare form of left ventricular aneurysm that can sometimes involve the mitral valve. This tutorial illustrates the technical aspects of posterior wall left ventricular aneurysm repair.
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http://dx.doi.org/10.1510/mmcts.2017.007DOI Listing
April 2017

Yasui procedure.

Multimed Man Cardiothorac Surg 2016 12 9;2016. Epub 2016 Dec 9.

University Hospital of Lausanne.

There are rare situations in which the left ventricular outflow tract cannot be used for systemic output. The Yasui procedure allows leaving the left ventricle as the systemic ventricle, but uses the pulmonary valve as the systemic semilunar valve. These videos illustrate the technical aspects of the Yasui procedure.
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http://dx.doi.org/10.1510/mmcts.2016.005DOI Listing
December 2016

Delayed hyperbaric oxygen therapy for air emboli after open heart surgery: case report and review of a success story.

J Cardiothorac Surg 2016 Dec 5;11(1):167. Epub 2016 Dec 5.

Division of Cardiac Surgery, County Hospital, University of Geneva, Geneva, Switzerland.

Background: The current case describes a rare diagnosis of iatrogenic air emboli after elective cardiopulmonary bypass that was successfully treated with delayed hyperbaric oxygen therapy, with good clinical evolution in spite of rare complications.

Case Presentation: A 35 years old male was admitted to the intensive care unit (ICU) for post-operative management after being placed on cardiopulmonary bypass (CPB) for an elective ventricular septal defect closure and aortic valvuloplasty. The patient initially presented with pathologically late awakening and was extubated 17 h after admission. Neurologic clinical status after extubation showed global aphasia, mental slowness and spatio-temporal disorientation. The injected cerebral CT scan was normal; the EEG was inconclusive (it showed metabolic encephalopathy without epileptic activity); and the cerebral MRI done 48 h after surgery showed multiple small subcortical acute ischemic lesions, mainly on the left fronto- parieto- temporo-occipital lobes. He was taken for hyperbaric oxygen therapy (HOT) over 54 h after cardiac surgery. The first session ended abruptly after 20 min when the patient suffered a generalised tonico-clonic seizure, necessitating a moderately rapid decompression, airway management, and antiepileptic treatment. In total, the patient received 7 HOT sessions over 6 days. He demonstrated full neurological recovery at 4 weeks and GOS (Glasgow Outcome Scale) of 5 out of 5 even after a long delay in initial management. Convulsions are a rare complication of HOT either due to reperfusion syndrome or hyperoxic toxicity and can be managed. Prior imaging by MRI or tympanic paracentesis (myringotomy) should not add further delay of treatment.

Conclusion: HOT should be initiated upon late awakening and/or neurologic symptoms after CPB heart surgery, after exclusion of formal counter-indications, even if the delay exceeds 48 h.
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http://dx.doi.org/10.1186/s13019-016-0553-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5139121PMC
December 2016

Norwood Stage 1 With Surgical Ventricular Reconstruction and Mitral Valve Repair for Neonatal Idiopathic Left Ventricular Dilated Cardiomyopathy.

Ann Thorac Surg 2016 Jul;102(1):e15-7

Pediatric Cardiology, Geneva University Children's Hospital, Geneva, Switzerland.

A newborn girl presented with a prenatal diagnosis of dilated left ventricular cardiomyopathy, mitral valve regurgitation, and ductal-dependent circulation. The left ventricle was severely dilated and hypokinetic. The patient underwent Norwood stage 1 single ventricle palliation with a Damus-Kaye-Stansel anastomosis, atrioseptectomy, and a modified Blalock-Taussig shunt. The left ventricle was managed with Batista surgical ventricular reconstruction, with resection of the dilated and thinned ventricular myocardium, along with periventricular Alfieri repair of the mitral valve. The patient had an uneventful postoperative recovery, followed by stage 2 bidirectional Glenn and tricuspid valvuloplasty at 2.75 months of age.
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http://dx.doi.org/10.1016/j.athoracsur.2015.11.005DOI Listing
July 2016

Airway compression management in late-presenting absent pulmonary valve syndrome.

Cardiol Young 2015 Feb 2;25(2):295-300. Epub 2014 Jan 2.

2Division of Cardiovascular Surgery, Faculty of Medicine,Geneva University Hospitals,Geneva,Switzerland.

Introduction: Patients with absent pulmonary valve syndrome often present early with airway compression from aneurysmal pulmonary arteries. This study reviews our experience in managing absent pulmonary valve syndrome in later presenting children, and techniques used for managing airway compression.

Methods: This study is a retrospective chart review of all patients who underwent repair of absent pulmonary valve syndrome from 2000 to 2012 at our institution. The primary endpoints were post-operative bronchoscopic and clinical evidence of persistent airway compression and need for reinterventions on the pulmonary arteries.

Results: A total of 19 patients were included during the study period. The mean age at repair was 4.1±3.0 years (range 10 months-11 years). In all, seven patients had pre-operative bronchoscopic evidence of airway compression, which was managed by pulmonary artery reduction plasty in four patients and Lecompte manoeuvre in three patients. There were no peri-operative deaths. In patients with pulmonary artery plasty, two had no post-operative airway compression, one patient had improved compression, and one patient had unchanged compression. In patients managed with a Lecompte manoeuvre, two patients had no or trivial airway compression and one had improved compression. There were six late reinterventions or reoperations on the pulmonary arteries - two out of four in the pulmonary artery plasty group and one out of three in the Lecompte group.

Conclusions: Most late-presenting patients with absent pulmonary valve syndrome do not have airway compression. Either pulmonary artery reduction plasty or the Lecompte manoeuvre can relieve proximal airway compression, without a significantly different risk of pulmonary artery reintervention between techniques.
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http://dx.doi.org/10.1017/S1047951113002151DOI Listing
February 2015

Incidental gossypiboma discovered during tricuspid valve re-repair 11 years after Ebstein anomaly repair.

Heart Surg Forum 2013 Aug;16(4):E216-8

Division of Cardiovascular Surgery, Geneva University Hospitals and School of Medicine, Geneva.

Background: A retained surgical sponge, an extremely rare occurrence after cardiac surgery, can trigger a granulomatous reaction and form a sizeable mass or gossypiboma. We report the incidental operative finding of a gossypiboma 11 years after repair of Ebstein anomaly.

Case Report: A 24-year-old man, who had previously undergone tricuspid annuloplasty for Ebstein anomaly 11 years earlier at another institution, was referred for recurrent severe tricuspid regurgitation. During the dissection along the superior vena cava and the right atrium, we entered 2 cystic cavities that exuded a pus-like material, which was sent for culture. Mesh from a retained surgical sponge (gossypiboma) was identified. After complete debridement and administration of vancomycin, the tricuspid valve was repaired. Antibiotics were continued until culture results were confirmed to be negative. The patient's postoperative course was uneventful, and he presented no signs of infection.

Conclusions: We report a rare case of incidentally found gossypiboma after cardiac surgery.
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http://dx.doi.org/10.1532/HSF98.20131015DOI Listing
August 2013