Anubhav Gupta

Puneet Garg, Rajat Nandi, Geetika Sindhwani, Subrata Pramanik, Anubhav Gupta, Amita Malik, and Supriya Kaur. Int J Gastrointest Interv -0001;0:. https://doi.org/10.18528/ijgii250101

Purpose Transversus thoracic muscle plane block (TTPB) is an upcoming modality for analgesia post-sternotomy. We aimed to evaluate the effect of pre-operative TTPB on post-operative analgesia in cardiac surgical patients undergoing sternotomy. Methods Seventy patients (18–65 years) of either gender, posted for cardiac surgery needing midline sternotomy, were prospectively enrolled and block randomized into two groups of 35 each —group T (receiving TTPB) and group C (control). Post-operative analgesia was monitored using the Numerical Rating Scale (NRS) during rest, cough, and incentive spirometry. Diaphragmatic excursion and arterial blood gases (ABG) were used to measure post-operative respiratory function, along with total opioid consumption and the duration of post-operative mechanical ventilation. Results NRS at rest, during cough and spirometry was significantly lower in group T at 6, 12, and 24 h post-surgery (p < 0.0001). Bilateral diaphragmatic excursion (at rest and maximal inspiration) was reduced more in group C than group T (p < 0.0001 at 12 h and 24 h post-operatively). Mean opioid consumption in the first 24 h after surgery was much lesser in group T (232.29 µg vs 373 µg, p < 0.0001), along with a lesser need for rescue analgesia in the same group. The mean duration of mechanical ventilation was 9.31 h in group T and 11.53 h in group C (p < 0.0001). Conclusion Administering TTPB prior to midline sternotomy in cardiac surgeries is an effective way of providing post-operative analgesia. It also improves the diaphragmatic excursion, reduces opioid consumption, and aids in faster extubation. Trial registration The study has been registered with the Clinical Trials Registry of India prior to patient enrolment. (CTRI/2022/10/046536). Link to webpage- https://ctri.nic.in/Clinicaltrials/regtrial.php?trialid=75409&EncHid=13705.55824&modid=1&compid=19 Date of registration: 17/10/2022. Date of first patient enrollment: 21/10/2022. Graphical Abstract

Purpose This study evaluates the safety, efficacy, reproducibility and short-term clinical outcomes of robotic mitral valve replacement (MVR). Methods Between September 2022 and May 2024, 64 robotic cardiac and thoracic surgeries were performed in our institute. Twelve consecutive patients who underwent MVR using da Vinci Xi robotic system were retrospectively analysed. It was performed by right side approach using four instrument ports and one 4-cm working port, under peripheral cardiopulmonary bypass (CPB) with transoesophageal echocardiography (TEE) surveillance. Results The mean age of patients was 39 ± 9 years (median = 42 years), male-to-female ratio of 1:2, left ventricular ejection fraction (LVEF) = 60 ± 5%. The mean CPB and aortic cross clamp (ACX) time was 273 ± 119 min (174–568 min) and 160 ± 91 min (85–395 min) respectively. All patients received mechanical valve. The ventilation time and length of intensive care unit (ICU) stay was 21 ± 8 h and 3 ± 2 days respectively. The median drain output was 258 ml (Interquartile Range (IQR) = 240–353ml). Two patients (16.67%) were re-explored the same day in view of excessive drain output. Two patients required postoperative opioid analgesics (16.67%). One (8.33%) patient had groin wound infection. There was no mortality. Patients were ambulated from postoperative day 3.91 ± 1.80 days. Duration of hospital stay post-surgery was 9 ± 3 days, and patients were discharged after therapeutic International Normalised Ratio (INR) of 3 was achieved. Postoperative pain score of study group was 3 ± 1 (mild). Patients were satisfied with aesthetically pleasing scar and returned to routine activity within 4 ± 1 weeks. The mean follow-up time was 10.17 ± 5.11 months. Conclusion Robotic MVR surgery is safe and has excellent short-term outcomes. Patients experienced less pain and faster recovery.

Prosthesis-patient mismatch after aortic valve replacement is associated with increased morbidity and mortality. A myriad of techniques have been described for aortic root enlargement to circumvent this problem. We review the salient techniques with their merits, demerits, and results.

A sinus of Valsalva aneurysm arising from the left coronary cusp and rupturing into the superior vena cava is extremely rare. We performed patch closure of such an aneurysm in a 23-year-old female who presented with syncopal attacks, exertional dyspnea, and chest pain. Recent advances in diagnostic techniques facilitated the planning of treatment. The complexity of the anatomical course precluded a catheter-based intervention. Surgical closure remains the treatment of choice in complex cases.

Background: Placement of mediastinal drains after cardiac surgery is standard of care. However, there is no consensus over the number of drains to be placed. Is there any advantage of multiple drains over a single drain? This question formed the premise of this study.Methods: All consecutive patients operated between 2014 and 2015 were included. Those with pleural drains were excluded. Patients had either a single drain in the pericardial cavity or had two drains, one in the pericardial and the other in retrostenal area. A total of 244 patients were included in the study group.Results: Out of 244 patients, 122 had single drain and 122 had 2 mediastinal drains. The mean age was 24.38±17.08 (Age range 6 months to 66 years) and male: female ratio was 1.5:1. There was no statistically significant difference in single drain vs double drain group in terms of the number of days of drainage (1.65 vs 1.55, p 0.325), time to mobilize (36.57 vs 35.23 hours, p=0.684), ICU stay (2.62 vs 2.63 days, p=0.96)and re-exploration (5.7%, vs 9.8%, p=0.34). However, patients with two mediastinal drains had higher requirement of analgesia (p=0.004).Conclusions: The use of two mediastinal drains does not confer any advantage over a single mediastinal drain after cardiac surgery in assessing or controlling bleed or recovery. However, the post-operative pain is significantly higher with use of two mediastinal drains.

Chondrosarcoma is the most common malignancy of the sternum. Removal of the sternum for a malignant tumor results in large defects in bone and soft tissue, causing deformity and paradoxical chest wall movement, making subsequent repair of the thorax very important. Herein we report a rare case of recurrent anterior chest wall chondrosarcoma after surgery 4 years earlier. The patient underwent resection of the chondrosarcoma followed by three-layer chest wall reconstruction with a split rib graft for the bony defect. He had an uneventful postoperative course and was healthy at 9 months postoperatively.