Mediastinal Bleeding Research Articles

Mitral valve surgery in octogenarians: long-term and hemodynamic results.

Octogenarians are often denied mitral valve (MV) surgery secondary to concerns over increased perioperative morbidity and mortality. The objective of this study was to examine the outcomes of octogenarians undergoing mitral valve repair (MVr) and replacement (MVR). The outcomes of 139 patients between the ages of 80-90 who underwent MVR/MVr between 2004-2018 at the Mazankowski Alberta Heart Institute (Edmonton, AB, Canada) were retrospectively analyzed. Follow-up was extended to a maximum of 15.8 years. Following MVR, all-cause mortality at 30 days, 1 year, 5 years, 10 years, and the longest follow-up was 7%, 14%, 36.3%, 61.8%, and 67.7%, respectively. Post-MVr, all-cause mortality at the same time points was 1.9%, 7.6%, 22.5%, 55.5%, and 100%, respectively. During the Hospitalization Index, rates of new-onset atrial fibrillation, sepsis, acute kidney injury, superficial sternal wound infection, deep sternal wound infection, mediastinal bleeding, and permanent pacemaker insertion ranged from 22.1-34.0%, 3.8-11.0%, 7.6-22.0%, 1.9-2.4%, 0-1.2%, 0%, and 0-6.1%, respectively. Rates of overall rehospitalization, as well as readmission for heart failure, stroke, myocardial infarction, and MV reoperation ranged from 71.0-85.5%, 52.2-63.3%, 10.9-22.8%, 1.9-6.0%, and 0% during the follow-up period. There were significant reductions in peak MV gradient (P=0.042) and left ventricular internal diameter in diastole (LVIDd; P=0.008) post-MVR, as well as LVIDd (P<0.001) and Left Atrial (LA) Volume Index (P=0.019) post-MVr. Octogenarians exhibit positive left atrial and left ventricular remodeling following MVR. Perioperative morbidity is low, late survival is reasonable, and long-term morbidity is considerable. Overall, these results add to the growing literature that MV surgery is relatively safe and effective in octogenarians.

Mediastinal hematoma after trans-radial cerebral angiography: a case report

BackgroundTrans-radial (TRA) access has become increasingly prevalent in neurointervention. Nonetheless, mediastinal hematoma after TRA is an infrequent yet grave complication associated with a notably elevated mortality rate. While our review found no reported mediastinal hematoma cases managed conservatively within neuro-interventional literature, similar complications are documented in cardiac and vascular interventional radiology, indicating its potential occurrence across disciplines.Case PresentationCarotid computed tomography angiography (CTA) showed calcified plaques with stenosis (Left: Severe, Right: Moderate) in the bilateral internal carotid arteries (ICAs) of an 81-year-old male presented with paroxysmal weakness in the right upper limb. Dual antiplatelet therapy with aspirin and clopidogrel was administered. On day 7, DSA of the bilateral ICAs was performed via TRA. Post-DSA, the patient experienced transient loss of consciousness, chest tightness, and other symptoms without ECG or MRI abnormalities. Hemoglobin level decreased from 110 g/L to 92 g/L. Iodinated contrast-induced laryngeal edema was suspected, and the patient was treated with intravenous methylprednisolone. Neck CT indicated a possible mediastinal hemorrhage, which chest CTA confirmed. The patient’s treatment plan involved discontinuing antiplatelet medication as a precautionary measure against the potential occurrence of an ischemic stroke instead of the utilization of a covered stent graft and surgical intervention. Serial CTs revealed hematoma absorption. Discharge CT showed a reduced hematoma volume of 35 × 45 mm.ConclusionsThis case underscores the need for timely identification and precise manipulation of guidewires and guide-catheters through trans-radial access. The critical components of successful neuro-interventional techniques include timely examination, rapid identification, proper therapy, and diligent monitoring.

Impact of Sex on Long-Term Outcomes Following Surgical Aortic Valve Replacement

The impact of sex on outcomes following surgical aortic valve replacement (SAVR) remains unclear. It has been proposed that females experience inferior outcomes, but this has yet to be conclusively established, particularly in the long term. The objective of this study is to identify discrepancies in postoperative outcomes between males and females following SAVR to better inform consideration for surgical intervention. We retrospectively reviewed the outcomes of 4,927 patients who underwent SAVR from 2004 to 2018 at our centre. In total, 531 propensity-matched males and females were included in the final analysis. The primary outcome was mortality at any point during the follow-up period. Secondary outcomes included various measures of postoperative morbidity. Follow-up duration was 15 years. In SAVR all-comers, females experienced inferior short-term mortality, but equivalent mid-term and long-term mortality. Rates of mediastinal bleeding, sternal wound infections, sepsis, heart failure, and pacemaker insertion were all equivalent between the sexes; however, males experienced a higher rate of acute kidney injury and readmission for stroke at the longest follow-up while females experienced a longer intensive care unit and hospital length of stay. In a sub-analysis of isolated SAVR, males and females experienced equivalent early, mid, and late mortality. Of note, a trend towards increased aortic valve reoperation was noted in females at the longest follow-up. Males and females experience equivalent long-term mortality following isolated SAVR. Sex is not an independent risk factor of poor outcomes post-SAVR; however, the increased preoperative risk profile of females requires diligent consideration.

Clinical features, paraclinical characteristics, and etiology of mediastinal bleeding diffusion in children at the Vietnam National Children’s Hospital from 2018 to 2023

Background: In modern life, diffuse alveolar haemorrhage (DAH) is a serious and rare condition in children. Due to the subtle clinical manifestations and diverse causes of the disease, it is easy to be missed or diagnosed late. This study describes clinical and paraclinical characteristics, with the aim to find signs suggesting early diagnosis as well as determine the cause of DAH in children. Objects and methods: Case series. Results: From January 2018 to March 2023, there were 14 children diagnosed with DAH. The age of onset is 4.08 (1.58-5.41) years old, but most patients are diagnosed late with age at diagnosis being 5.25 (1.67-6.16) years old, male/female ratio is 1:1.8. The most common symptoms reported were anaemia (100%), hemoptysis (57.1%), shortness of breath (71.4%), and respiratory failure (85.7%). The common X-ray finding was diffuse infiltrates in both lungs (92.9%). On chest computed tomography scans, 92.9% of patients exhibited images of blurred opacity spreading, 57.1% showed interlobar pleural thickening, and 28.6% presented with images of lung consolidation. 3 patients (22%) had milk allergy, 2 patients (14%) had ANCA (Anti-neutrophil cytoplasmic antibody) vasculitis, and 9 patients (64%) had idiopathic pulmonary haemosiderosis (IPH).

Sternal protection technique for open chest management

On some occasions, postoperative mediastinal bleeding or right ventricular failure forces surgical teams to pursue a strategy of open-chest management and delayed sternal closure. One notable source of postoperative bleeding is the sternum, either due to medullar bleeding or bone margin oozing, which may be difficult to control. Furthermore, in cases with right ventricular failure or dilatation needing an open-chest strategy, sternal margins might erode and injure the right ventricular anterior wall. We propose a simple but effective sternal protection technique during open-chest management and further delayed chest closure. Using leftover tubing from the cardiopulmonary bypass circuit or a mediastinal 32 Fr drain, both sternal margins are covered and secured with sutures. Moreover, in case of profuse bleeding, a thrombin-derived haemostatic agent can be applied between the bone marrow and the tube for an additional level of haemostasis. The sternal wound is isolated with a latex membrane and covered with transparent sterile adhesive sheets to achieve vacuum sealing.

Complicated hematomediastinum in a 76-year-old patient after performing an endosonographically guided transbronchial cryobiopsy (EBUS-TBCB) with suspected lymphoma

We present the case of a patient with severe complications from mediastinal bleeding after endosonographically guided transbronchial cryobiopsy (EBUS-TBKB) with suspected advanced lymphoma. The EBUS-TBKB is a new effective examination method in interventional pneumology for the diagnosis of diseases with mediastinal lymph node enlargement and intrathoracic tumors, with which large tissue cylinders in the mediastinum can be obtained. Due to the high diagnostic value of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) for the clarification of lymphadenopathy, the examination should not be carried out as a routine application. Indications for a primary EBUS-TBKB arise when there is a suspicion of intrathoracic malignant lymphomas or other rare tumors in which extensive unfragmented tissue material is required for diagnosis. A rare complication that has not yet been described in the literature is a hematomediastinum, so that a careful risk assessment of possible bleeding complications should be carried out before intervention and the more invasive mediastinoscopy can be a safer examination method.

Blood transfusion in aortic root surgery impairs midterm survival

ObjectiveTo evaluate the effect of perioperative allogeneic packed red blood cell (RBC) transfusion during aortic root replacement. MethodWe reviewed patients undergoing aortic root replacement at our institution between March 2014 and April 2020. In total, 760 patients underwent aortic root replacement, of whom 442 (58%) received a perioperative RBC transfusion. Propensity score matching was used to account for baseline and operative differences resulting in 159 matched pairs. All-cause mortality was assessed with Kaplan–Meier curves. Data were obtained from our institutional Society of Thoracic Surgeons database and chart review. ResultsAfter propensity score matching, the RBC-transfused and -nontransfused groups were similar for all preoperative characteristics. Cardiopulmonary bypass time, crossclamp time, and lowest operative temperature were similar between the transfused and nontransfused groups (standardized mean difference <0.05). RBC transfusion was associated with more frequent postoperative ventilation greater than 24 hours (36/159 [23%] vs 19/159 [12%]; P = .01), postoperative hemodialysis (9/159 [5.7%] vs 0/159 [0%]; P = .003), reoperation for mediastinal hemorrhage (9/159 [5.7%] vs 0/159 [0%]; P = .003), and longer intensive care unit and hospital length of stay (3 vs 2 days and 8 vs 6 days respectively; P < .001). Thirty-day operative mortality after propensity score matching was similar between the cohorts (1.9%; 3/159 vs 0%; P = .2), and 5-year survival was reduced in the RBC transfusion cohort (90.2% [95% confidence interval, 84.1%-96.7%] vs 97.1% [95% confidence interval, 92.3%-100%] P = .035). ConclusionsAortic root replacement frequently requires RBC transfusion during and after the operation, but even after matching for observed preoperative and operative characteristics, RBC transfusion is associated with more frequent postoperative complications and reduced midterm survival.

Pevonedistat, a Nedd8-activating enzyme inhibitor, in combination with ibrutinib in patients with relapsed/refractory B-cell non-Hodgkin lymphoma

Pevonedistat (TAK924) is a Nedd8-activating enzyme inhibitor with preclinical activity in non-Hodgkin lymphoma (NHL). This open-label, Phase I, multicenter, investigator-sponsored study enrolled patients with relapsed/refractory (R/R) NHL and chronic lymphocytic leukemia (CLL). The primary objective was safety. Pevonedistat was given intravenously on days 1, 3, 5 of a 21-day cycle for 8 cycles at five dose levels (15 to 50 mg/m2); ibrutinib was administered at 420 or 560 mg orally daily continuously. Eighteen patients with NHL were enrolled, including 8 patients with mantle cell lymphoma (MCL) and 4 patients with CLL. One dose-limiting toxicity (mediastinal hemorrhage) occurred at 50 mg/m2 of pevonedistat which is the estimated maximum tolerated dose. Bruising and diarrhea were the most common adverse events (56% and 44%). Atrial fibrillation occurred in 3 patients (17%). Grade ≥3 toxicities included arthralgia, atrial fibrillation, bone pain, diarrhea, hypertension, and mediastinal hemorrhage (one patient each). The overall response rate (ORR) was 65% (100% ORR in MCL). Pevonedistat disposition was not modified by ibrutinib. scRNA-Seq analysis showed that pevonedistat downregulated NFκB signaling in malignant B-cells in vivo. Thus, pevonedistat combined with ibrutinib demonstrated safety and promising early efficacy in NHL and CLL. NAE inhibition downregulated NFκB signaling in vivo.

Comparison of Sternal Wound Complication after Off-Pump CABG between Skeletonized and Pedicled LIMA Harvesting: A Single Centre Experience in Bangladesh

Background: Off-pump coronary artery bypass grafting (OPCAB) is a surgical procedure that has gained popularity due to its potential benefits over traditional coronary artery bypass grafting, including reduced morbidity and mortality. However, sternal wound complication (SWC) remains challenging following the procedure. The technique of left internal mammary artery (LIMA) harvesting has been shown to impact the incidence of SWC. This study aimed to compare the incidence of SWC between two techniques of LIMA harvesting, i.e., skeletonized and pedicled. Methods: The study was conducted at the Department of Cardiac Surgery, Bangabandhu Sheikh Mujib Medical University, and included 60 patients who underwent OPCAB. The patients were divided into two groups of 30 each based on the technique of LIMA harvesting used, i.e., skeletonized (group A) or pedicled (group B). The postoperative ICU care was given to each patient as per the protocol. The statistical analysis was conducted using the SPSS version 26.0 for Windows software. Results: The results showed that 5 (8.33%) patients developed SWC, with 1 (1.67%) patient in group A and 4 (6.66%) patients in group B. However, the occurrence of SWC was not statistically significant between the two groups (p = 0.35). The mean age, gender distribution, and comorbidities such as hypertension, diabetes, dyslipidemia, and anemia were also not statistically significant between the two groups. The number of smokers was statistically significant between the two groups (p = 0.03), and the occurrence of SWC was found to be higher in smoker patients in group B (p = 0.04). Preoperative and postoperative parameters such as duration of operation, duration of mechanical ventilation, duration of chest drains, duration of the central venous line, and amount of postoperative mediastinal bleeding were also not statistically significant between the two groups. The distribution of wound complications, duration of ICU stays, and hospital stay between the two groups was also not statistically significant. Conclusion: In conclusion, this study found that the incidence of SWC was less in skeletonized LIMA harvesting than in pedicled LIMA harvesting after OPCAB. However, this finding was not statistically significant. Further studies with larger sample sizes may be needed to confirm these results and determine the appropriate technique of LIMA harvesting to decrease the incidence of SWC after OPCAB.

Experience With SynCardia Total Artificial Heart as a Bridge to Transplantation in 100 Patients

BackgroundThe SynCardia temporary total artificial heart (TAH-t) is an effective bridge to transplantation for patients with severe biventricular failure. However, granular single-center data from high-volume centers are lacking. We report our experience with the first 100 TAH-t recipients. MethodsA prospective institutional database was used to identify 100 patients who underwent 101 TAH-t implantations between 2012 and 2022. Patients were stratified and compared according to Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) profile 1 vs 2 or greater. Median follow-up on device support was 94 days (interquartile range, 33-276), and median follow-up after transplantation was 4.6 years (interquartile range, 2.1-6.0). ResultsOverall, 61 patients (61%) were successfully bridged to transplantation and 39 (39%) died on TAH-t support. Successful bridge rates between INTERMACS profile 1 and INTERMACS profile 2 or greater patients were similar (55.6% [95% CI, 40.4%-68.3%] vs 67.4% [95% CI, 50.5%-79.6%], respectively; P = .50). The most common adverse events (rates per 100 patient-months) on TAH-t support included infection (15.8), ischemic stroke (4.6), reoperation for mediastinal bleeding (3.5), and gastrointestinal bleeding requiring intervention (4.3). The most common cause of death on TAH-t support was multisystem organ failure (n = 20, 52.6%). Thirty-day survival after transplantation was 96.7%; survival at 6 months, 1 year, and 5 years after transplantation was 95.1% (95% CI, 85.4%-98.4%), 86.6% (95% CI, 74.9%-93.0%), and 77.5% (95% CI, 64.2%-86.3%), respectively. ConclusionsAcceptable outcomes can be achieved in the highest acuity patients using the TAH-t as a bridge to heart transplantation.

S2836 Gastrohepatic Ligament Bronchogenic Cyst Diagnosed by EUS FNA

Introduction: Bronchogenic cysts pose diagnostic and therapeutic challenges due to its varied locations and presentations. Case Description/Methods: 58-year-old woman presented with two weeks of epigastric and RUQ abdominal pain. Presenting labs: TB 4.3 mg/dL, DB 3.4 mg/dL, AP 328 U/L, AST 1,265 U/L, ALT 1,890 U/L. Workup was negative for pancreatitis, acute hepatitis, and acetaminophen toxicity. CT scan showed biliary duct dilatation with a 5mm stone in the common bile duct, and a 3.5 x 3.6 cm thick-walled mass with rim enhancement and hypodense central component within the gastrohepatic ligament (GHL) (A). EUS characterized the mass as a hypoechoic cystic lesion with a concentric 4mm thick wall (B). Fine needle aspiration (FNA) of the cyst produced 14ml of brown and viscous fluid. After cyst aspirate, FNA of the decompressed cyst wall was also performed. Cyst fluid amylase was < 3 U/L, CEA was 157 ng/mL, and cytology was negative for malignancy. Cytology of the cyst wall showed benign ciliated columnar epithelial cells consistent with a bronchogenic cyst (C). ERCP was performed during EUS for stone extraction. She then underwent cholecystectomy with improvement of symptoms and liver enzymes. Her asymptomatic bronchogenic cyst is undergoing active surveillance. (Figure) Discussion: Bronchogenic cysts are foregut-derived malformations of the respiratory tract and while relatively rare, is the most common primary cyst of the mediastinum accounting for 6-15% of primary mediastinal masses. The location depends on the embryological stage of development when the anomaly occurs. Most are in the mediastinum and uncommonly in the lung parenchyma, esophagus, heart, subdiaphragm, and retroperitoneum. Only one other case has been reported of a bronchogenic cyst in the GHL. Reported prevalence is 1:42,000-68,000 admissions in two hospital series. Some present with symptoms such as cough, fever, pain, and dyspnea. Complications can arise with compression of mediastinal structures, recurrent infection, hemorrhage, rupture, and malignant degeneration. Others are asymptomatic and incidentally found on chest radiograph or cross-sectional imaging. No standard exists for treatment. Traditionally, patients underwent surgical excision for definitive diagnosis and management. EUS FNA serves as a less invasive method for diagnosis. Controversy still exists regarding management of asymptomatic cysts with several reports advocating for complete removal due to likelihood of development of symptoms and potential for serious illness.Figure 1.: CT, EUS, Cytology.

Acute Mediastinal Bleeding with Pleural Escape: Case Report of a Rare Interventional Complication with Unusual Resolve

AbstractAcute mediastinal bleeding is a very rare complication of cardiac intervention. It is a life-threatening situation when this condition causes acute compression of the mediastinal area. A 59-year-old man was diagnosed with inferior ST-elevation myocardial infarction with ongoing chest pain and underwent an urgent percutaneous coronary intervention procedure. After coronary stent was implanted, patient complained of chest tightness, and suffocation, blood pressure dropped, O2 saturation dropped, and was difficultly intubated. Image acquisition by C-arm showed a large bulging in aortic arch area. Contrast-enhanced computed tomography ruled out aortic dissection, but noted a large mediastinal mass that was radiated to the neck. The bulging was spontaneously regressed, and a large left pleural effusion was developed. Left pleural tapping was performed on day 7, and a total of 1.5-L hemorrhagic fluid was evacuated. In our case, unusual drainage from mediastinal to pleural space has probably save the patient.

536. PREVENTING ESOPHAGO-GASTRIC ANASTOMOTIC LEAKS; THE ROLE OF LOAD-BEARING SUTURES

Abstract The leak rate of esophago-gastric anastomosis remains at 10 to 30% despite technological advances and robotic techniques. From the moment of recovery from anaesthesia, the anastomosis is subjected to incessant distraction by the diaphragm with each inspiratory effort. It was hypothesized that eliminating all possible tension on the anastomosis during the vulnerable healing phase, by employing tension-bearing sutures between conduit and pleura, would provide the greatest opportunity for success. This study evaluated such a strategy. A prospectively maintained database of all esophagectomies performed over a 21-year period, was interrogated for the anastomotic leak rate following the introduction of a tension-elimination anastomotic technique. This consisted of securing the gastric conduit to the mediastinal pleura using load-bearing sutures inserted obliquely. When these were secured, the anastomosis became floppy, and remaining so throughout the vulnerable phase of healing, when collagenase digestion reduces anastomotic tensile strength by two-thirds. All patients had a contrast study performed between day 5 to 7 and all intra-hospital mortalities underwent autopsy to determine the cause of death. Clinical, radiological and autopsy leaks were recorded. There were 145 intra-thoracic esophago-gastric anastomoses created in 143 patients (two patients required salvage re-resection for tumour recurrence); of which 77% were male, and 65.3% were for adenocarcinoma. Fifty-five percent were stapled and 45% were hand-sewn. There was only 1 confirmed leak during the study period and 1 patient died from a mediastinal haemorrhage, which at autopsy was considered to possibly be the result of sepsis as a result of an occult anastomotic leak. The low anastomotic leak-rate is attributed to the protective effect of the load-bearing sutures; preventing any traction on the anastomosis, the most incessant source of which is the piston-like action of the diaphragm and the gripping of the diaphragmatic crura. It is intuitive that eliminating all tension during the most vulnerable phase of healing would also reduce any risk posed by minor impairments of blood supply or technical imperfections of anastomotic technique, facilitating anastomotic success.

Outcomes of expanded polytetrafluoroethylene pericardial membrane implantation in left ventricular assist device explantation and heart transplantation.

Redo sternotomy and explantation of left ventricular assist devices (LVAD) for heart transplantation (HT) involve prolonged dissection, potential injury to mediastinal structures and/or bleeding. Our study compared a complete expanded polytetrafluoroethylene (ePTFE) wrap versus minimal or no ePTFE during LVAD implantation, on outcomes of subsequent HT. Between July 2005 and July 2018, 84 patients underwent a LVAD implant and later underwent HT. Thirty patients received a complete ePTFE wrap during LVAD implantation (Group 1), and 54 patients received either a sheet of ePTFE placed in the anterior mediastinum or no ePTFE (Group 2). Baseline characteristics were similar between Groups 1 and 2. Surgeons reported subjective improvements in speed, predictability, and safety of dissection with complete ePTFE compared with minimal or no ePTFE. Time from incision to initiation of cardiopulmonary bypass (CPB) were similar between groups (97 ± 38 vs. 89 ± 29 min, p = .3). Injury to mediastinal structures during the dissection was similar between groups (10% vs. 11%, p > .9). While surgeons reported less intraoperative bleeding in Group 1 (43% vs. 61%), this trend did not reach significance (p = .1). In-hospital mortality, intensive care unit length of stay and hospital length of stay were similar between both groups. In patients undergoing LVAD explant-HT, there was a trend towardreduced surgeon reported intraoperative bleeding with ePTFE placement. Despite qualitatively reported greater ease and speed of mediastinal dissection with ePTFE membrane placement, time to initiation of CPB did not differ, likely because surgeons remained cautious, allowing extra time for unanticipated difficulties.

Ácido láctico y asociación con la mortalidad en el posoperatorio de cirugía cardiaca. Estudio cohorte retrospectiva

ObjectiveTo analyse the behaviour of lactic acid in the first 24h after surgery in cardiac surgery, and conditions associated with its elevation and impact on clinical evolution as a factor associated with mortality. DesignObservational, analytical, retrospective cohort study, repeated measures. Scope4-Level clinical cardiovascular intensive care unit in Colombia. ParticipantsPatients over 18 years of age who were admitted to the intensive care unit in the postoperative period of cardiac surgery with the need for extracorporeal circulation. InterventionsMeasurement of lactic acid 0, 6, 12, 18 and 24h after surgery. Variable of interestLactic acid, mediastinal bleeding, extracorporeal circulation time, aortic clamp time, overall in-hospital mortality. ResultsA total of 214 people were included, the most frequent surgery was aortic change (43.9%), hypertension was present in 48.6% of the patients, the overall in-hospital mortality was 5.6%, the time of average hospital stay in ICU 3 days, during follow-up lactic acid was higher in those who died, with the greatest difference at 12h, with the variables that influence the change in lactic acid were aortic clamp time, mediastinal bleeding >1000cc, urea nitrogen and the use of two inotropes, the factors that increase the risk of mortality were lactic acid greater than 3mmol/l RR 13.96 CI 1.55–125.9; p-value=.019, and mediastinal bleeding >1000cc, RR: 2.55 (CI: 1.00-6.51), p-value=.049. ConclusionLactic acid was shown to be an associated factor for mortality at different times of monitoring, always higher in the people who died.

Heart-Lung Transplantation: Technical Modifications to Simplify the Procedure

Heart-lung transplantation is a mature therapy but has perioperative complications, such as phrenic nerve dysfunction and mediastinal bleeding. We report our technical modifications to simplify the procedure.

A retrospective study of 51 pediatric cases of traumatic asphyxia

BackgroundTraumatic asphyxia (TA) is a rarely reported disease characterized as thoraco-cervico-facial petechiae, facial edema and cyanosis, subconjunctival hemorrhage and neurological symptoms. This study aimed to report 51 children of TA at the pediatric medical center of west China.MethodsScanned medical reports were reviewed and specific variables as age, sex, cause of injury, clinical manifestations and associated injuries were analyzed using SPSS 25.0.ResultsThe average age of patients was 5.3 ± 2.9 (1.3–13.2) year-old. Thirty (58.8%) were boys and 21 (41.2%) were girls. Most TAs occurred during vehicle accident, object compression and stampede. All patients showed facial petechiae (100.0%, CI 93.0–100.0%), 25 (49.0%, CI 34.8–63.2%) out of 51 presented with facial edema, 29 (56.9%, CI 42.8–70.9%) presented with subconjunctival hemorrhage, including bilateral 27 and unilateral 2. Six patients had facial cyanosis (11.8%, CI 2.6–20.9%). Other symptoms were also presented as epileptic seizure, vomiting, incontinence, paraplegia, etc. The most frequent companion injury was pulmonary contusion (76.5%, CI 64.4–88.5%). Other companion injuries included mediastinal emphysema, fracture, cerebral contusion and hemorrhage, hypoxic-ischemic brain injury, abdominal organ contusion, mastoid hemorrhage, hematocele of paranasal sinuses, spinal cord injury, hepatic insufficiency, myocardial injury and retinal hemorrhage and edema. Treatment was mainly supportive. No death occurred in our study. The prognosis is rather good if without damage of central nervous system.ConclusionTA could bring out multiple symptoms, among which retinal hemorrhage and edema, spinal cord injury and viscera impairment have been less observed. Comprehensive physical and auxiliary examination should be performed considering TA. Its prognosis is rather good with focus on life-threatening complications.

Efficacy and Safety of Tropical Use of Tranexamic Acid during Off-Pump Coronary Artery Bypass Surgery: A Randomized Control Trial

Background: Postoperative mediastinal bleeding in patients undergoing cardiac surgery is still one of the most common complications.&#x0D; Objective: This study was intended to investigate the efficacy of topical tranexamic acid in reducing postoperative bleeding after post-operative cardiovascular surgery.&#x0D; Methodology: In this non-randomized, double blinded, clinical trial, patients undergoing Off-Pump Coronary Artery Bypass (OPCAB) surgery in NICVD, Dhaka, Bangladesh during January 2014 to December 2015 and fulfilling inclusion and exclusion criteria were recruited. They were assigned in two groups- 30 patients in tranexamic acid group (Group 1) and 30 patients in placebo group (Group 2). On completion of the grafting, before closure of the sternum tranexamic acid (2.5 g/25 mL) or placebo (25 mL of saline) diluted in 100 mL of warm saline (370 C) was instilled into the pericardial cavity including the mediastinal tissues and left for 5 minutes. Then it was cleared out by wall sucker and sternum was closed.&#x0D; Results: There was no significant difference in baseline demographic data, basic clinical characteristics and preoperative coagulation profile between the 2 groups (P &gt; 0.05). Total mediastinal bleeding in group 1 and group 2 patients were421.67±70.32 vs 593.33±77.38ml, p&lt;0.001. In case of, whole blood transfusion in group 1 and group 2 patients were 0.87±0.0.73 units and1.77±0.57 units respectively, p&lt;0.001.&#x0D; Conclusion: No patient required reoperation for bleeding and there was no incidence of prolonged ventilation, MI, thromboembolism, DVT or CVA in any of the patients in either group.&#x0D; Journal of National Institute of Neurosciences Bangladesh, July 2021, Vol. 7, No. 2, pp. 142-146

Clinical Evaluation of Titanium-Alloy Bands for Sternal Closure after Median Sternotomy: Single-Center Experience.

Background Median sternotomy is the most applied approach in open-heart surgery, while potential complications such as postoperative bleeding, sternal dehiscence, and deep sternal wound infection (DWSI) still remain a challenge to cardiac surgeons. Several new sternum-closure products instead of stainless wire have been brought into clinical application. The objective of this retrospective study is to evaluate the novel sternum-fixing product in terms of clinical outcomes. Methods 689 consecutive cases undergoing cardiac surgery through median sternotomy between February 2015 and December 2018 in our center were enrolled in this study. All the cases were divided into two groups according to different sternum fixation methods: wire cerclage group and rigid fixator group. The demographic as well as clinical data including the mediastinal drainage of first, second, and third post-op 24 hours, the total mediastinal drainage of post-op 72 hours, ICU duration, length of hospital stay, and post-op mortality in 30 days were collected and compared between the two groups. Results 278 cases were enrolled in the wire cerclage group and 411 cases in the rigid fixator group. There is no significant difference in the demographic data between the two groups, while the mediastinal drainage in the first and third 24 hours after surgery and the total mediastinal drainage in postoperative 72 hours of the rigid fixator group were significantly less than those of the wire cerclage group (P < 0.05). No significant difference was found in other clinical outcomes between the groups including ICU duration, LOS in hospital, and 30-day mortality. 14 cases (5.0%) in the wire cerclage group and 11 cases (2.7%) in the rigid fixator group had sternotomy-related complications including severe postoperative bleeding, sternal dehiscence, and DSWI. Conclusion Compared with the conventional wire cerclage, the new rigid fixator is superior in median sternotomy closure in terms of postoperative mediastinal bleeding as well as incidence of sternotomy-related complications.

Emergency Transcatheter Arterial Embolization for Acute Mediastinal Hemorrhage.

The aim of this study was to investigate the application value of transcatheter arterial embolization (TAE) for mediastinal hemorrhage. The study retrospectively analyzed the status of TAE treatment in 13 patients with mediastinal hemorrhage. Aortic angiography and bleeding artery angiography showed that the bleeding in 13 mediastinal hemorrhage patients, respectively, originated from intercostal artery, esophageal artery, or bronchial artery. All patients were embolized with gelatin sponge and (or) polyvinyl alcohol particles. Chest computed tomography scan found that all 13 patients showed reduced range of mediastinal hematoma after TAE. TAE has the advantages of reduced trauma, rapid and direct hemostasis, and solid therapeutic effects in the treatment of mediastinal hemorrhage.