Postoperative Tamponade Research Articles

Safety and effectiveness of left atrial appendage closure in atrial fibrillation patients with different types of heart failure

BackgroundBoth atrial fibrillation (AF) and heart failure (HF) are common cardiovascular diseases. If the two exist together, the risk of stroke, hospitalization for HF and all-cause death is increased. Currently, research on left atrial appendage closure (LAAC) in patients with AF and HF is limited and controversial. This study was designed to investigate the safety and effectiveness of LAAC in AF patients with different types of HF.MethodsPatients with non-valvular atrial fibrillation (NVAF) and HF who underwent LAAC in the First Affiliated Hospital of Army Medical University from August 2014 to July 2021 were enrolled. According to left ventricular ejection fraction (LVEF), the study divided into HF with reduced ejection fraction (LVEF < 50%, HFrEF) group and HF with preserved ejection fraction (LVEF ≥ 50%, HFpEF) group. The data we collected from patients included: gender, age, comorbid diseases, CHA2DS2-VASc score, HAS-BLED score, NT-proBNP level, residual shunt, cardiac catheterization results, occluder size, postoperative medication regimen, transthoracic echocardiography (TTE) results and transesophageal echocardiography (TEE) results, etc. Patients were followed up for stroke, bleeding, device related thrombus (DRT), pericardial tamponade, hospitalization for HF, and all-cause death within 2 years after surgery. Statistical methods were used to compare the differences in clinical outcome of LAAC in AF patients with different types of HF.ResultsOverall, 288 NVAF patients with HF were enrolled in this study, including 142 males and 146 females. There were 74 patients in the HFrEF group and 214 patients in the HFpEF group. All patients successfully underwent LAAC. The CHA2DS2-VASc score and HAS-BLED score of HFrEF group were lower than those of HFpEF group. A total of 288 LAAC devices were implanted. The average diameter of the occluders was 27.2 ± 3.5 mm in the HFrEF group and 26.8 ± 3.3 mm in the HFpEF group, and there was no statistical difference between the two groups (P = 0.470). Also, there was no statistically significant difference in the occurrence of residual shunts between the two groups as detected by TEE after surgery (P = 0.341). LVEF was significantly higher in HFrEF group at 3 days, 3 months and 1 year after operation than before (P < 0.001). At 45–60 days after surgery, we found DRT in 9 patients and there were 4 patients (5.4%) in HFrEF group and 5 patients (2.3%) in HFpEF group, with no significant difference between the two groups (P = 0.357). One patient with DRT had stroke. The incidence of stroke was 11.1% in patients with DRT and 0.7% in patients without DRT (P = 0.670). There was one case of postoperative pericardial tamponade, which was improved by pericardiocentesis at 24 h after surgery in the HFpEF group, and there was no significant difference between the two groups (P = 1.000). During a mean follow-up period of 49.7 ± 22.4 months, there were no significant differences in the incidence of stroke, bleeding, DRT and HF exacerbation between the two groups. We found a statistical difference in the improvement of HF between HFrEF group and HFpEF group (P < 0.05).ConclusionsLAAC is safe and effective in AF patients with different types of HF. The improvement of cardiac function after LAAC is more pronounced in HFrEF group than in HFpEF group.

Comparison of Propofol and Sevoflurane Anaesthesia in Terms of Postoperative Nausea-Vomiting Complication in Cardiac Surgery Patients Undergoing Enhanced Recovery After Surgery Protocol: A Prospective Randomized Study.

Postoperative nausea (PN) and vomiting (PONV) in cardiac surgery increases adrenergic stimulation, limits mobilization and oral intake, and can be distressing for patients. The primary aim of our study was to investigate the effect of sevoflurane and propofol anaesthesia on the incidence of PONV in cardiac surgery patients undergoing Enhanced Recovery After Surgery (ERAS) protocol. Following ethics committee approval, 62 patients undergoing elective coronary artery bypass surgery with ERAS protocol were included in this prospective randomized study. After standard induction of anaesthesia, Group S received 1.5-2% sevoflurane and Group P received 50-100 μg kg-1 min-1 propofol infusion as maintenance anaesthetic agent with a bispectral index of 40-50. The incidence of PN and PONV between 0-6 hours (early) and 6-24 hours (late) after extubation was compared as the primary outcome. The incidence of delirium was analyzed as a secondary outcome for similar periods. In the propofol group, 3 patients were excluded due to postoperative tamponade revision and prolonged mechanical ventilation. PN in the early post-extubation period (29% vs. 7.1%, P=0.031) was significantly higher in Group S. The incidence of delirium was similar between the groups in both periods. Propofol may reduce the incidence of PN in the first 6 hours after extubation compared with sevoflurane. We believe that this period will be beneficial for gastrointestinal tolerance as it is the period when oral intake is initiated in patients. In conclusion, propofol maintenance in cardiac surgery patients may facilitate patient rehabilitation as part of the ERAS protocol.

Thymic MALT lymphoma associated with Sjögren’s syndrome with postoperative cardiac tamponade and acute pleuritis: a case report

BackgroundThymic mucosa-associated lymphoid tissue (MALT) lymphoma is rare and is known to be associated with Sjögren’s syndrome (SjS). SjS is rarely accompanied by serositis. Here, we describe the first case of postoperative cardiac tamponade and acute pleuritis in a patient with thymic MALT lymphoma associated with SjS.Case presentationA 33-year-old woman with SjS presented with an anterior mediastinal mass on chest computed tomography, which was performed for further examination of the condition. Suspecting a thymic MALT lymphoma or thymic epithelial tumor, total thymectomy was performed. The mediastinal mass was histopathologically diagnosed as a thymic MALT lymphoma. The patient was discharged with a good postoperative course but visited the hospital 30 days after surgery for dyspnea. Cardiac tamponade was observed and drainage was performed. Four days after pericardial drainage, chest radiography revealed massive left pleural effusion, and thoracic drainage was performed. The patient was diagnosed with serositis associated with SjS and treated with methylprednisolone, which relieved cardiac tamponade and pleuritis.ConclusionsSurgical invasion of thymic MALT lymphomas associated with SjS may cause serositis. Postoperative follow-up should be conducted, considering the possibility of cardiac tamponade or acute pleuritis due to serositis as postoperative complications.

Posterior pericardiotomy and the prevention of post-operative atrial fibrillation and cardiac tamponade in isolated coronary artery bypass grafting – A retrospective analysis

BackgroundPost-Operative Atrial Fibrillation (POAF) is the most frequent complication of cardiac surgery and is associated with reduced survival, increased rates of cognitive changes and cerebrovascular accidents, heart failure, renal dysfunction, infection, length of stay and hospital costs. Cardiac tamponade although less common, carries high morbidity and mortality. Shed mediastinal blood in the pericardial space is a major source of intrapericardial oxidative stress and inflammation that triggers POAF. The utilisation of a posterior pericardiotomy (PP) aims to shunt blood from pericardium into the pleural space and have a role in the prevention of POAF as well as cardiac tamponade.Methods2168 patients had undergone isolated Coronary Artery Bypass Grafting at Royal Hobart Hospital from 2008 to 2022. They were divided into PP group vs. control group. Patient baseline demographics, intraoperative data and post-operative outcomes were reviewed retrospectively.ResultsTotal incidence of new POAF and cardiac tamponade was 24% and 0.74% respectively. Primary outcome of both the incidence of POAF (20.2% vs. 26.3%, p < 0.05) and Cardiac Tamponade (0% vs. 1.1%, p < 0.05) were less in the pericardiotomy group. A subgroup analysis of patients with recent myocardial infarction showed reduced incidence of POAF in the PP group (p < 0.05). Increasing age, Body Mass Index, poor left ventricular ejection fraction (EF < 30%) and return to theatre were independent predictors of developing POAF. There were similar rates of return to theatre for bleeding however, no cases of tamponade in the pericardiotomy group. There were no complications attributable to left posterior pericardiotomy and the time added to the duration of surgery was minimal.ConclusionPosterior pericardiotomy is associated with a significant reduction in the incidence of POAF and cardiac tamponade which is safe and efficient.

Hemorrhagic pericardial tamponade in a hemodialysis patient with catheter-related superior vena cava syndrome: a case report

BackgroundIatrogenic complications of endovascular treatment for central venous stenosis have not yet been reported. Here we present a case of a patient on maintenance hemodialysis who developed catheter-related superior vena cava syndrome and subsequently suffered from hemorrhagic pericardial tamponade after undergoing percutaneous transluminal angioplasty and stenting.Case presentationA 72-year-old male patient presented with uremia, and had been receiving maintenance hemodialysis for the past five years. The patient initially presented with dysfunction of the dialysis catheter (a cuffed tunneled double-lumen catheter in the right internal jugular vein). Imaging examination revealed a segmental occlusion of the superior vena cava stretching from the distal end of the dialysis catheter up to right atrium entrance, apparent compensatory dilatation of the azygos vein, and abundant subcutaneous collaterals. The patient underwent percutaneous transluminal balloon dilatation and stenting (covered stent) of the superior vena cava in the Cath Lab. During the procedure, with forceful advancement of the guidewire, it was observed to progress for a distance before a “smoke” appeared, and an outward spillage of contrast agent was visible, which suggested a possible vessel puncture leading into the mediastinum. Unfortunately, postoperative hemorrhagic pericardial tamponade occurred and the patient developed cardiogenic shock. He experienced symptoms included chest tightness and breath shortness with a recorded blood pressure of 84/60mmHg. After draining 600 ml of bloody fluid through pericardiocentesis, the patient’s symptoms alleviated and his condition improved.ConclusionsThe case emphasizes the need for increased attention to iatrogenic endovascular injuries during catheter placement and endovascular treatment, such as causing pericardial hemorrhage leading to cardiac tamponade.

Optimization of Platelet-Rich Plasma Fraction Selection for Surgical Treatment of Macular Holes

Objective: based on clinical and morpho — functional analysis of retinal restoration and assessment of the cellular composition of platelet-rich plasma, to determine its optimal fraction for surgical treatment of macular hole. Materials and methods. This study presents the results of 120 cases of surgical treatment of eyes with macular hole. The patients were divided into 2 groups. In the 1st group (60 eyes), the technology developed in our clinic was used without the use of postoperative tamponade of the vitreal cavity and the use of autologous platelet-rich plasma (PRP), in the 2nd — traditional technology for the treatment of macular hole s (60 eyes). The cellular composition of the PRP of 30 patients was analyzed. Results. 2 months after surgery, 119 patients had the restoration of all retinal layers in the macular hole area and positive dynamics of visual acuity was recorded in comparion with the preoperative period. After observation for 6 months after surgery, cases of recurrence of macular hole were not detected. Conclusion. The therapeutic value of BoTP lies in the tamponing and regenerative effect. According to the results of this study, for maculrupture surgery, it is rational to use plasma from a layer of pure platelet-rich plasma (P-PRP), which contains a sufficient number of platelets capable of having a positive therapeutic effect, and a minimum number of leukocytes capable of performing the functions of immune protion and repair of the retiand surrounding tissues.

Transcatheter Aortic Valve Implantation Using the Transcervical Vascular Access (from a 7-Year Experience from a Swiss Tertiary Center)

The gold-standard transfemoral (TF) access for transcatheter aortic valve implantation (TAVI) is not suitable in 10% to 15% of patients, and alternative accesses are needed. Studies have suggested that the transcervical (TC) access might yield outcomes comparable to the TF access. In our center, TC-TAVI is the first-line alternative to TF-TAVI. We herein present our 7-year experience regarding the use of the TC access in TAVI. We included all consecutive patients referred for TC-TAVI between January 1, 2016 and December 31, 2022. Data regarding the patients' characteristics,perioperative and 30-day outcomes were prospectively collected. Patients were separated into 2 temporal groups (group 1: January 1, 2016 to June 30, 2019; group 2: July 1, 2019 to December 31, 2022) to assess the changes of their characteristics and outcomes over time. A total of 95 patients were included, with more belonging to group 2 (n=56 vs n=39 in group 1). Patients in group 2 were significantly younger (81.0 [interquartile range 77.0 to 87.0] vs 89.0 [interquartile range 83.0 to 92.0] years, p <0.001) and had a higher prevalence of hypertension (87.5% vs 66.7%, p=0.028) and chronic pulmonary disease (35.7% vs 15.4%, p=0.029). There was no significant difference regarding other co-morbidities or surgical scores. All-cause mortality and the risk of stroke at 30days were low and similar (group 2 vs group 1, 3.6% vs 2.5%, p=0.787 and 1.8% vs 0%, p=0.397, respectively), as were the risks of permanent pacemaker implantation, postoperative acute kidney injury, cardiac tamponade, life-threatening bleeding, and major vascular complications. In conclusion, the use of the TC access increased over time. The rates of adverse events did not change, despite patients from mid-2019 onward having slightly more co-morbidities.

Acute clinical and financial outcomes of on- versus off-pump coronary artery bypass grafting in octogenarians

BackgroundCoronary artery bypass surgery in octogenarians is associated with increased postoperative morbidity. Off-pump coronary artery bypass surgery eliminates potential complications of cardiopulmonary bypass, but its use remains controversial. This study aimed to evaluate the clinical and financial impact of off-pump coronary artery bypass surgery compared to conventional coronary artery bypass surgery among this high-risk population. MethodsPatients ≥80 years undergoing first-time, isolated, elective coronary artery bypass surgery were identified using the 2010–2019 Nationwide Readmissions Database. Patients were grouped into off-pump or conventional coronary artery bypass surgery cohorts. Multivariable models were developed to assess the independent associations between off-pump coronary artery bypass surgery and key outcomes. ResultsOf ∼56,158 patients, 13,940 (24.8%) underwent off-pump coronary artery bypass surgery. On average, the off-pump cohort was more likely to undergo single-vessel bypass (37.3 vs 19.7%, P < .001). After adjustment, undergoing off-pump coronary artery bypass surgery was associated with similar odds of in-hospital mortality (adjusted odds ratio 0.90, 95% confidence interval 0.73–1.12) relative to conventional bypass. Additionally, the off-pump and conventional coronary artery bypass surgery groups were comparable in odds of postoperative stroke (adjusted odds ratio 1.03, 95% confidence interval 0.78–1.35), cardiac arrest (adjusted odds ratio 0.99, 95% confidence interval 0.71–1.37), ventricular fibrillation (adjusted odds ratio 0.89, 95% confidence interval 0.60–1.31), tamponade (adjusted odds ratio 1.21, 95% confidence interval 0.74–1.97), and cardiogenic shock (adjusted odds ratio 0.94, 95% confidence interval 0.75–1.17). However, the off-pump coronary artery bypass surgery cohort was linked with an increased likelihood of ventricular tachycardia (adjusted odds ratio 1.23, 95% confidence interval 1.01–1.49) and myocardial infarction (adjusted odds ratio 1.34, 95% confidence interval 1.16–1.55). Furthermore, those undergoing off-pump coronary artery bypass surgery demonstrated reduced odds of non-home discharge (adjusted odds ratio 0.91, 95% confidence interval 0.83–0.99) and a decrement in hospitalization expenditures ($-1,290, 95% confidence interval –$2,370 to $200). ConclusionOff-pump coronary artery bypass surgery was linked with increased odds of ventricular tachycardia and myocardial infarction, but no difference in mortality. Our findings point to the safety of conventional coronary artery bypass surgery in octogenarians. Yet, future work is needed to consider long-term outcomes in this complex surgical cohort.

Gallese proctological swab

The author has devised and perfected an effective postoperative anorectal tamponade system, very easy, extremely economical and well tolerated by the patient.

Emergent Bedside Resternotomy: An Innovative Simulation Model for Training Pediatric Cardiac Intensive Care Teams

AbstractCardiac tamponade after cardiac surgery is a life-threatening event that requires simultaneous resuscitation and emergent resternotomy by the intensive care team. A simulated scenario using an innovative mannequin with sternotomy wound has the capability of reproducing cardiac arrest associated with postoperative tamponade. We evaluated the validity of this mannequin to investigate the confidence level and crisis resource management skills of the team during bedside resternotomy to manage postoperative cardiac tamponade. The simulation scenario was developed using the sternotomy mannequin for a pediatric cardiac intensive care unit (CICU) team. The case involved a 3-year-old male, intubated, and mechanically ventilated after surgical repair of congenital heart disease, progressing to cardiac arrest due to cardiac tamponade. We conducted a formative learner assessment before and after each scenario as well as a structured, video debriefing following each encounter. The simulation was repeated in a 6-month interval to assess knowledge retention and improvement in clinical workflow. The data were analyzed using student t-test and chi-square test, when appropriate. Of the 72 CICU providers, a significant proportion of providers (p &lt; 0.0001) showed improved confidence in assessing and managing cardiac arrest associated with postoperative cardiac tamponade. All providers scored ≥3 for the impact of the scenario on practice, teamwork, communication, assessment skills, improvement in cardiopulmonary resuscitation, and opening the chest and their confidence in attending similar clinical situations in future. Most (96–100%) scored ≥3 for the perception on the realism of mannequin, the scenario, reopening the sternotomy, and level of stress. Time to diagnosis of cardiac tamponade (p = 0.004), time to the first dose of epinephrine (p = 0.045), and median number of interruptions to chest compressions (p = 0.006) all significantly decreased between the two sessions. Time to completion of resternotomy improved by 81.4 seconds; however, this decrease was not statistically significant. Implementation of a high-fidelity mannequin for postoperative cardiac tamponade simulation can achieve a realistic and reproducible training model with positive impacts on multidisciplinary team education.

Outcomes of Using Perfluorocarbon Liquid as Postoperative Tamponade in Complex Inferior Retinal Detachments.

To determine the outcomes of using perfluorocarbon liquid (PFCL) as postoperative tamponade in complex inferior retinal detachments. Quasi-experimental study. Layton Rahmatullah Benevolent Trust (LRBT) Eye Hospital, Karachi, Pakistan, from January 2020 to December 2021. This study was carried out on forty eyes of forty patients from the surgical retina clinic with rhegmatogenous inferior retinal detachment involving macula having proliferative vitreoretinopathy grade C (PVR grade-C). All eyes underwent 25G pars plana vitrectomy with PFCL as postoperative tamponade for 15 to 21 days. All patients were advised to maintain supine position postoperatively. PFCL-Silicon oil exchange was done after 15-21 days. The outcomes were measured as complete retinal reattachment between the neurosensory retina (NSR) and retinal pigment epithelium (RPE), changes in postoperative visual acuity and complications. Patients were followed up for a minimum duration of 6 months. Data were analysed using SPSS version 23. In 39 out of 40 eyes (97.5%) retina was completely attached. Postoperative visual acuity was improved in 24 eyes (60%), while in 16 eyes (40%) it remained stable. Worsening of visual acuity was not noted in any case. During follow-ups, uveitis was detected in 2 eyes (5%), cataract in 4 eyes (10%), optic atrophy in 2 eyes (5%) and endophthalmitis and subsequently redetachment in 1 eye (2.5%). In complex inferior retinal detachments, PFCL is safe and effective postoperative tamponade provided it is used for a short-term period, especially in those patients who are noncompliant with postoperative face-down position. Perfluorocarbon liquid (PFCL), Postoperative tamponade, Complex inferior retinal detachments.

Remote functional and anatomical results of idiopathic macular hole surgery performed without postsurgical vitreous cavity tamponade

Purpose. To assess remote results of our method of macular hole (MH) surgery without postsurgical vitreous cavity tamponade. Material and methods. 34 eyes of34 patients were operated for full-thickness MH 100 to 932 (558.5 ± 50.9) microns in diameter with no vitreous cavity tamponade. Before surgery, best corrected visual acuity (BCVA) was 0.02 to 0.25 (0.11±0.02). The operation included 3-port 25—27 G vitrectomy, separation of posterior hyaloid membrane, staining and removal of the internal limiting membrane (ILM) with subsequent ex­change of salt solution for air. The hole edges were passively (without touching the retina) pulled towards the center using an extrusion cannula through air supplied into the vitreous cavity under the pressure of 20—25 mm Hg. After that, 0.05 to 0.1 ml of platelet rich plasma (PRP) of the patient was applied to macular hole zone. In 2 minutes, a fibrin film was formed at the place of application which was pressed to the retina by injecting 0.5 ml of Perfluororganic Compound liquid (PFCL) into the vitreous cavity. PFCL was exposed for 3 minutes, whereupon it was passively aspirated. The operation was completed by air exchanged for salt solution. High specific weight of PFCL facilitated a tight adhe­sion of fibrin film to the retina. The follow-up period was 1 to 20 months (7.9±0.8 on average). Results. After the surgery, complete closure of the macular hole was achieved in 32 of 34 cases (94.1%). No intraoperative or postoperative complications were observed. Postsurgical BCVA improved to 0.3—0,7(0.50 ± 0.05). At the initial stage of the study, a recurrence ofMH took place in two cases associated with partial mechanical displacement of the fibrin film by the cannula during PFCL removal. Conclusions. The proposed method of macular hole surgery avoiding postoperative vitreous cavity tamponade with gas or another vitreous substitute is effective, speeds up the rehabilitation and may be used in routine clinical practice, especially in patients with the only seeing eye, those with a transparent lens, those who need to take a plane or rise at great heights soon after the surgery, as well as those at risk of increased IOP or unable to sustain a forced head position even for a short time span.

The Results of the Treatment of the Recurrent “Inferior” Retinal Detachment Depending on the Volume of Surgical Intervention

Purpose: to analyze the results of the treatment recurrent «inferior» retinal detachments (RD) depending on the volume of surgical intervention.Patients and methods. 81 patients (81 eyes) with recurrent «inferior» RD were included in this retrospective study. Groups were identified depending on the volume of surgical treatment of recurrents RDs: scleral buckling (SB), pars plana vitrectomy (PPV), combined surgery: PPV with SB, PPV with retinotomy (RT), including the use of perfluorocarbon fluid (PFCL). The volume of surgical treatment was assessed before recurrent RD, after the first and second recurrent «inferior» RD, the distribution of the grade and type of proliferative vitreoretinopathy (PVR) complicating these recurrents RD with different treatment tactics, analyzed the functional results and anatomical success (retinal reattachment) after surgical treatment of the first and second recurrents RD.Results. Primary anatomical success was achieved in 304 from 385 patients (79 %). In 81 cases, the first recurrent RD was detected (21 %). Surgical treatment of the first recurrent RD included: in 39 cases (48 %) — PPV; in 9 cases (11 %) — PPV with SB; in 13 cases (16 %) — PPV with RT. In 20 cases (25 %) for short-term tamponade with PFCL was used when performing PPV with RT. The second recurrent RD occurred in 42 cases, which accounted for 52 % of the first recurrent RD. The anterior type of PVR was in all cases (100 %). All patients underwent repeated surgery: PPV (100 %), of which in 15 cases (35.7 %) — PPV with RT; the use of short-term postoperative tamponade with PFCL was in 18 cases (42.9 %); additional SB — in 9 cases (21.4 %). Anatomical success was achieved in 100 % of cases after surgical treatment of the second recurrent RD, but in 8 cases (19 %) a retinal redetachment occurred.Conclusion. The increase in PVR continues to be the main cause of recurrent RD. In patients with recurrent «inferior» retinal detachments, grade C PVR type 4, 5, the additional use of SB for PPV, RT and the use of PFCL as a short-term postoperative tamponade allows achieving better results (functional and anatomical). During surgery of the second recurrent RD, when there are pronounced changes in the retina, performing SB is impractical, the alternative is RT.

Comparison of Pericardiocentesis in Post-Cardiac Surgery and Nonsurgical Patients with Pericardial Tamponade.

IntroductionThere are several approaches for pericardiocentesis. However, there is no definite suggestion about puncture location after cardiac surgery. The purpose of this study is to examine whether there is any difference regarding puncture location during pericardiocentesis in postoperative cardiac tamponade comparing to nonsurgical cardiac tamponade.MethodsWe retrospectively analyzed patients who had undergone pericardiocentesis from August 2011 to December 2019. Patients were examined in two groups, nonsurgical and postsurgical, based on the etiology of pericardial tamponade. Clinical profiles, echocardiographic findings, and procedural outcomes were identified and compared.ResultsSixty-eight pericardiocenteses were performed in this period. The etiology of pericardial effusion was cardiac surgery in 27 cases and nonsurgical medical conditions in 41 cases. Baseline demographic variables were similar between the surgical and nonsurgical groups. Loculated effusion was more common in the postsurgical group (48.1% vs. 4.9%, P<0.001). Maximal fluid locations were different between the groups; right ventricular location was more common in the nonsurgical group (36.6% vs. 11.1%, P=0.02), while lateral location was more common in the postsurgical group (12.2% vs. 40.7%, P=0.007). Apical drainage was more frequently performed in the postsurgical group compared to the nonsurgical group (77.8% vs. 53.7%, P=0.044).ConclusionApical approach as a puncture location can be used more frequently than subxiphoid approach for effusions occurred after cardiac surgery compared to nonsurgical effusions. Procedural success is prominent in this group and can be the first choice of treatment.

Retina damage and repair after high-frequency monopolar electrocoagu-lation by suprachorioid access

Retinal detachment (RD), its rupture, concussion, hemorrhage require urgent ophthalmic surgical intervention without fail. Restoring the anatomical integrity of the detached retina, the speed of surgical intervention, the choice of access and method of surgery, the quality of the surgical instrument are directly causally related to visual acuity, the number and severity of postoperative complications. The best complex ophthalmosurgical solutions relieve vitreoretinal surgeons of the need for vitrectomy and postoperative tamponade, provide sufficient strength of the chorioretinal connection, cause little oedema in the surgical site, a minimal atrophy, and a quick repair process. An important objective indicator of the optimal choice of the tool, access and nature of the intervention is minimal damage of the retina neurolayer and a decrease in its thickness due to surgical impact. This publication is devoted to the second phase of an experiment on animals, which simulates an operation to restore the anatomical integrity of a detached retina. The parameters of high-frequency monopolar electrocoagulation (current 0.1 A, voltage 10–16 V, frequency 66 kHz, suprachoroidal access, instrument of the original design with a extreme part of sphere diameter of 25 G) remain unchanged. For the second phase of the experiment, 30 adult rabbits (60 eyes) were used, divided into three experimental groups (10 animals, 20 eyes each) according to the exposure voltage (I – 10–12 V, II – 12–14 V, III – 14–16 V) and euthanized 1 week, 2 weeks and 1 month after surgery. The experiment took into account the data of its first phase regarding the control (IV) group of animals, which included 6 intact rabbits (12 eyes), as well as observations 1 hour and 3 days after the operation. The morphological structure of rabbit eyes was studied with an emphasis on the processes of oedema, atrophy and thickness of the retina. Keywords: chorioretinal surgery, experimental ophthalmic surgery, retinal detachment, retinal thickness.

Surgical outcomes in inferior recurrences of rhegmatogenous retinal detachment.

To analyze the anatomical and functional outcomes in the inferior recurrences of rhegmatogenous retinal detachment (RRD) depending on the surgical approach. Eighty-one eyes of 81 patients (47 males and 34 females with a mean age of 54.8±14.1y) who demonstrated at least one inferior recurrence of RRD were included in this retrospective study. All patients were categorized as having received either circular scleral buckling (SB), pars plana vitrectomy (PPV), a combination of SB and PPV (SB+PPV), PPV with retinotomy (PPV+RT), or PPV+RT and short-term postoperative perfluorocarbon liquid tamponade (PPV+RT+pPFCL). All cases were followed up until successful retinal reattachment or third recurrence. The primary outcome measures were the achievement of the surgical goal without recurrence of RRD and best-corrected visual acuity (BCVA). After the treatment of the first recurrence, the recurrence rate in the PPV+SB group was statistically significantly lower than that of the PPV (P=0.0012), PPV+RT (P=0.028), or PPV+RT+pPFCL (P=0.047) group. There was no statistically significant difference between PPV+SB, PPV+RT, and PPV+RT+pPFCL groups in the recurrence rate after treatment of the second recurrence (42 eyes). However, there was a statistically significant (P=0.016) trend towards a decrease of recurrence rate after PPV+RT+pPFCL. There was no statistically significant improvement of BCVA in either study group (P>0.05) after both first and second recurrence surgery. The mean time follow-up was 109.0±91.0d before the first recurrence and 210.0±186.6d between previous surgery at second recurrence. Patients with first inferior recurrence of RRD may benefit from SB as an adjunct to PPV. RT and short-term pPFCL tamponade in the second recurrence may allow better anatomical outcomes, however, without functional improvement.

Retina changes in the early stages after high-frequency monopolar electrocoagulation through the suprachoroidal access

Retinal detachment (RD) is a condition that requires urgent ophthalmic surgery. Existing methods of RD vitreoretinal correction cause numerous complications and bring inconvenience to patients due to the need for vitrectomy and postoperative tamponade. Therefore, methods of RD surgical treatment are promising, which allow forming a strong chorioretinal adhesion in a short period of time after surgery, but damage the retina as little as possible. With this aim, in an experiment on rabbits, we studied the consequences of damage and features of retinal repair after high-frequency monopolar electrocoagulation (at a current of 0.1 A, 10–16 V and 66 kHz) by suprachoroidal access with an instrument of original design with a terminal sphere 25 G. For the experiment, 24 adult rabbits (48 eyes) were used, which were divided into three experimental groups (6 animals each, 12 eyes each) according to the exposure voltage (I – 10÷12 V, II – 12÷14 V, III – 14 ÷16 V) and one control (IV) group, which included 6 intact rabbits (12 eyes). Micropreparations obtained by us after euthanasia of animals early after surgery (after 1 hour and 3 days) showed us morphological changes in the eye tissues in places of direct contact with the electrode, remote and transitional areas. Edema processes prevailed among these changes. However, during this period, we could not investigate the processes of atrophy, which are also important for the recovery of acuity and visual fields after the recovery of RD. It was decided to monitor the animals for an additional period (until the end of the first month of the experiment), for which it will be necessary to increase the group of laboratory animals during the continuation of the experiment.

Risk analysis for early mortality in emergency acute type A aortic dissection surgery: experience of Tokyo Acute Aortic Super-network.

We investigated the various pre- and postoperative complications related to early (30-day) mortality after open surgery for acute type A aortic dissection. Data from the Tokyo Acute Aortic Super-network database spanning January 2015 to December 2017 were retrospectively reviewed. Pre- and postoperative factors related to early postoperative mortality were assessed in 1504 of 2058 (73.0%) consecutive patients [age: 66.6 (SD: 13.5) years, male: 52.9%] who underwent acute type A aortic dissection repair. The early mortality rate following surgical repair was 8.9%. According to multivariable analysis, male sex [odds ratio (OR) 1.670, 95% confidence interval (CI) 1.063-2.624, P = 0.026], use of percutaneous circulatory assist devices (n = 116, 7.7%) including extracorporeal membrane oxygenators or intra-aortic balloon pumps (OR 4.857, 95% CI 2.867-8.228, P < 0.001), shock (n = 162, 10.8%) (OR 3.06, 95% CI 1.741-5.387, P < 0.001), cardiopulmonary arrest (n = 41, 2.7%) (OR 7.534, 95% CI 3.407-16.661, P < 0.001), coronary ischaemia (n = 36, 2.3%) (OR 2.583, 95% CI 1.042-6.404, P = 0.041) and cerebral ischaemia (n = 59, 3.9%) (OR 2.904, 95% CI 1.347-6.261, P = 0.007) were independent preoperative risk factors for early mortality, while cardiac tamponade (n = 34, 2.3%) (OR 10.282, 95% CI 4.640-22.785, P < 0.001), cerebral ischaemia (n = 80, 5.3%) (OR 2.409, 95% CI 1.179-4.923, P = 0.016) and mesenteric ischaemia (n = 15, 1.0%) (OR 44.763, 95% CI 13.027-153.808, P < 0.001) were independent postoperative risk factors. Not only critical preoperative conditions but also postoperative cardiac tamponade and vital organ ischaemia are risk factors for early mortality after acute type A aortic dissection repair.

Effectiveness of posterior pericardiotomy in preventing cardiac tamponade and effusion pericarditis in the early period after interventions on the thoracic aorta

Background. Interventions on the thoracic aorta involving prolonged artificial circulation, clamping of the aorta and extensive dissection of the mediastinal structures are associated with a higher incidence of pericardial effusion and cardiac tamponade compared to other interventions. We suggest that routine implementation of posterior pericardiotomy may significantly affect the incidence of postoperative pericardial effusion syndrome and cardiac tamponade after interventions on the thoracic aorta.Aim. Evaluation of the effectiveness of posterior pericardiotomy regarding the development of cardiac tamponade, effusion pericarditis and the postoperative course of patients in the early period after interventions on the thoracic aorta.Methods. We conducted a retro- and prospective study that included 100 patients with thoracic aorta pathologies who were operated on in the cardiac surgery department of clinic from 2017 to 2020. All subjects were divided into two groups: a treatment group of 40 patients who underwent routine posterior pericardiotomy, and a control group of 60 patients without posterior pericardiotomy but with standard installation of postoperative drains. Assessment of the effect of posterior pericardiotomy on pericardial effusion, cardiac tamponade and the early postoperative period was conducted on the basis of transthoracic echocardiography that was performed daily during hospitalisation (the maximum amount of effusion during the observation period was taken as the control point), as well as up to one month after discharge from hospital.Results. The study groups did not differ regarding parameters such as time of artificial circulation (p = 0.39), time of myocardial ischaemia (p = 0.42), length of intensive care unit stay (p = 0.79) and length of hospitalisation (p = 0.21). Evaluation of pericardial effusion of varying severity during hospital follow-up revealed its presence in 15 (37.5%) patients in the PPt group and in 54 (90%) in the control group (p = 0.0001). Early postoperative cardiac tamponade developed in 4 (6.7%) patients in the control group, but was not observed in the PPt group (p = 0.09). At the same time, 5 (8.3%) patients without pericardiotomy required pericardiocentesis; however, this procedure was not performed in the PPt group (p = 0.06). Additionally, we did not find a statistically significant difference between the groups in relation to the frequency of puncture of the left pleural cavity (37.5% in the PPt group versus 43.3% in the control group, p = 0.56). According to the results of control echocardiography after one month, effusion of varying severity was found in 21 (35%) patients in the control group versus 1 (2.5%) in the PPt group (p = 0.0001).Conclusion. Posterior pericardiotomy is an affordable, applicable, safe and effective method for preventing postoperative pericardial effusion and cardiac tamponade after thoracic aortic surgery. This manipulation did not significantly affect the length of hospitalisation or the incidence of postoperative atrial fibrillation in this cohort of patients. Posterior pericardiotomy is not associated with a more frequent need for puncture of the left pleural cavity. Received 13 October 2020. Revised 10 December 2020. Accepted 11 December 2020. Funding: The study did not have sponsorship. Conflict of interest: Authors declare no conflict of interest.

Comparison of posterior pleural pericardial window and pericardiocentesis in patients with cardiac tamponade

Objective: In our study, we aimed to compare the results of patients who underwent pericardiocentesis and posterior pleura-pericardial window in the treatment of cardiac tamponade. Materials and Methods: The results of all patients presenting to our hospitals with cardiac tamponade and who underwent pericardiocentesis and/or posterior pleural pericardial window (PPPW) between January 2010 and May 2021 were compared and analyzed in a retrospective review. They were divided into Group A comprising 37 patients who underwent pericardiocentesis, and Group B comprising 37 patients who underwent PPPW. Results: The mean age was 62.8 ± 7.6 years, with 54.1% males in Group A compared to 59.5 ± 12.3 years and 62.2% males in Group B. The most common etiology in Groups A and B was idiopathic in 24.3% and 16.2%, respectively. Atrial fibrillation occurred in 32.4% versus 10.8% in Groups A and B, respectively (P < 0.02), and recurrent cardiac tamponade in 24.3% versus 5.4% in Groups A and B, respectively (P < 0.02). The 30 days' mortality was 5.4% versus 10.8% in Groups A and B, respectively (P < 0.39). Conclusions: Pericardiocentesis is a safe and effective treatment for cardiac tamponade in select cases; however, PPPW was associated with a lower incidence of postoperative atrial fibrillation and recurrent cardiac tamponade at 6 and 12 months' follow-up, respectively. PPPW appears a more effective treatment option, especially in recurrent pericardial effusion.