There is paucity of data on the impact of surgical incision and analgesia on relevant outcomes. A retrospective STROBE-compliant cohort study was performed between July 2007 and August 2017 of patients undergoing lung transplantation. Gender, age, indication for lung transplantation, and the 3 types of surgical access (Thoracotomy (T), Sternotomy (S), and Clamshell (C)) were used, as well as 2 analgesic techniques: epidural and intravenous opioids. Outcome variables were: pain scores; postoperative hemorrhage in the first 24 hours, duration of mechanical ventilation, and length of stay at intensive care unit (ICU). Three hundred forty-one patients were identified. Thoracotomy was associated with higher pain scores than Sternotomy (OR 1.66, 95% CI: 1.01; 2.74, P : .045) and no differences were found between Clamshell and Sternotomy incision. The median blood loss was 800 mL [interquartile range (IQR): 500; 1238], thoracotomy patients had 500 mL [325; 818] ( P < .001). Median durations of mechanical ventilation in Thoracotomy, Sternotomy, and Clamshell groups were 19 [11; 37] hours, 34 [IQR 16; 57.5] hours, and 27 [IQR 15; 50.5] hours respectively. Thoracotomy group were discharged earlier from ICU ( P < .001). Thoracotomy access produces less postoperative hemorrhage, duration of mechanical ventilation, and lower length of stay in ICU, but higher pain scores and need for epidural analgesia.

Pedicled BIMA use is associated with comparable incidences of sternal wound complications and other outcomes in diabetic patients and nondiabetic patients. Strict perioperative glycemic control, adherence to meticulous closure technique, and postoperative management of surgical wounds can make pedicled BIMA use a default strategy for diabetic patients.

A 59-year-old woman who was asymptomatic after a splenectomy for B-cell lymphoma was found to have a pedunculated mass filling 50% of the aortic lumen within the distal aortic arch on a routine follow-up computed tomographic scan of the chest (A/cover image, and B). She was referred to us with a differential diagnosis of tumor originating from the aortic wall. On transesophageal echocardiogram it seemed to be a solid mass rather than a floating thrombus. With suspicion of malignancy, it was decided to remove the mass surgically.Left thoracotomy was performed, and a 4-cm mass originating from the inner aspect of the distal aortic arch just above the remnant of the ductus arteriosus was excised on partial left heart bypass (C). The histology report showed a cylinder of pale hemorrhagic tissue, 4.0 ϫ 1.0 ϫ 0.8 cm, consisting of fibrin thrombus with a few atypical lymphoid cells present at one edge. However, this was insufficient for a firm diagnosis of malignancy.After surgery she received anticoagulant medication for 6 months. She remains well, with no evidence of recurrent thrombus after 3 years of follow-up.Nonaneurysmal aortic arch lesions are a frequent and a stillunderestimated source of stroke and peripheral embolization (in 10% of patients, the source of peripheral embolism cannot be identified). A floating thrombus in an apparently normal aortic arch is considered a life-threatening condition. Although rare, this diagnosis must not be overlooked in the search for etiology of recurrent and disseminated peripheral ischemic events, because of the significant morbidity and mortality related to a delayed diagnosis. Coagulopathies, atherosclerosis, trauma, malignancy, pregnancy, and previous aortic surgery are a few common causes of thrombus formation in this rare condition. There are various treatment options available, such as anticoagulation, balloon thrombectomy, stenting, and surgery. All these therapeutic modalities have their limitations; nonsurgical treatment involves high risk of embolism (reported as a 73% incidence of embolic events for highly mobile aortic thrombi as compared with 12% for immobile ones), 1 ischemia, and stroke, whereas surgery has been reported with high mortality and morbidity. Complicated vascular surgical procedures have been performed for definitive treatment. Primary tumors of the aorta are rare, and only a few cases are reported in the literature; as a result of our suspicion of tumor, we aimed to remove the lesion in a controlled manner under bypass, because no standard approach

OBJECTIVES Coronavirus disease 2019 is a new contagious disease that has spread rapidly across the world. It is associated with high mortality in those who develop respiratory complications and require admission to intensive care. Extracorporeal membrane oxygenation (ECMO) is a supportive therapy option for selected severely ill patients who deteriorate despite the best supportive care. During the coronavirus disease 2019 pandemic, extra demand led to staff reorganization; hence, cardiac surgery consultants joined the ECMO retrieval team. This article describes how we increased service provisions to adapt to the changes in activity and staffing. METHODS The data were collected from 16 March 2020 to 8 May 2020. The patients were referred through a dedicated Web-based referral portal to cope with increasing demand. The retrieval team attended the referring hospital, reviewed the patients and made the final decision to proceed with ECMO. RESULTS We reported 41 ECMO retrieval runs during this study period. Apart from staffing changes, other retrieval protocols were maintained. The preferred cannulation method for veno-venous ECMO was drainage via the femoral vein and return to the right internal jugular vein. There were no complications reported during cannulation or transport. CONCLUSIONS Staff reorganization in a crisis is of paramount importance. For those with precise transferrable skills, experience can be gained quickly with appropriate supervision. Therefore, the team members were selected based on skill mix rather than on roles that are more traditional. We have demonstrated that an ECMO retrieval service can be reorganized swiftly and successfully to cope with the sudden increase in demand by spending cardiac surgeons services to supplement the anaesthetic-intensivist roles.

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