Minimally invasive cardiac surgical procedure in a patient with breast implants by use of a fibrous capsule preservation method

Minimal-Invasive Mitral Valve Repair after Breast Augmentation

Minimal-invasive mitral valve surgery after breast augmentation is an ongoing interdisciplinary challenge. Notably, the perioperative explantation of the breast implant, as reported in most cases, is of questionable benefit. We herein report on successful minimal-invasive mitral valve repair after subpectoral breast augmentation with perioperative preservation of the breast implant in situ.

Breast Implant-Related Outcomes After Cardiothoracic Surgeries and Electrophysiologic Procedures

BACKGROUND

Outcomes related to preexisting breast implants after cardiothoracic procedures are poorly characterized. This study evaluated complications after minimally invasive cardiac surgery (MICS), median sternotomy (MS), and electrophysiologic procedures (EP) in patients with preexisting breast implants.

METHODS

A retrospective review of patients with prior breast implants who underwent MICS, MS, or EP from 1994 to 2019 was performed. Demographic, treatment, and outcome characteristics were recorded. χ2 Test and analysis of variance were used to perform statistical comparisons.

RESULTS

In total, 78 patients (37 MICS, 21 MS, and 20 EP) were identified. Mean breast implant age was 13.3, 11.7, and 10.2 years, respectively (P = 0.235). Intraoperative plastic surgeon involvement was present in 26 (70.3%) MICS cases, compared with 2 (9.5%) MS and 0% EP (P < 0.001). Intraoperative rupture occurred in 5 (13.5%) MICS cases and no MS or EP cases (P < 0.001). Postoperative implant complications occurred in 6 (16.2%) MICS, 8 (38.1%) MS, and 5 (25.0%) EP (P = 0.350) cases, with median time to complication of 5.9, 5.4, and 38.9 months, respectively (P = 0.596). Revision surgery was performed in 5 (13.5%) MICS, 7 (33.3%) MS, and 5 (25.0%) EP (P = 0.246) cases. On multivariate analysis, lack of intraoperative plastic surgeon involvement (P = 0.034) and breast implant age (P = 0.001) were significant predictors of postoperative complications.

CONCLUSIONS

Long-term complication rates are highest among patients with breast implants undergoing MS. Plastic surgeon involvement was significantly associated with fewer postoperative complications. Our results support a multidisciplinary approach to managing breast implants during cardiothoracic procedures.

Incidence and Distribution of Cerebral Embolism After Cardiac Surgery According to the Systemic Perfusion Strategy - A Diffusion-Weighted Magnetic Resonance Imaging Study

BACKGROUND

Stroke is a major concern in minimally invasive cardiac surgery, so we investigated the incidence and risk factors of cerebral embolism according to the systemic perfusion strategy under thorough imaging assessment.Methods and Results:Between November 2011 and May 2015, 315 cardiac surgery patients who underwent preoperative computed tomography angiography (CTA) as a routine evaluation were enrolled. The incidence and distribution of cerebral embolism were analyzed with routine postoperative brain diffusion-weighted magnetic resonance imaging (DW-MRI) examination. Anterograde perfusion was used in 103 patients (group A), and retrograde perfusion was performed in 212 patients (group R). Operative deaths, incidence of clinical stroke (group A: 0%, group R: 0.5%, P=0.77), and rate of cerebral embolism (group A: 35.9%, group R: 26.4%, P=0.08) were comparable. The median number of new embolic lesions detected by MRI per patient (group A: 2, group R: 2, P=0.16), maximal diameter of the lesion (group A: 6.5 mm, group R: 6.0 mm, P=0.97), and anatomic distribution of the lesion were similar between groups. In the multivariate analysis, hypertension, emergency status, atherosclerosis grade 3 or 4 (intimal thickening >4 mm), and cardiopulmonary bypass time were independent risk factors for postoperative cerebral embolism, but retrograde perfusion was not.

CONCLUSIONS

According to the results of postoperative DW-MRI, retrograde perfusion itself might not increase the incidence of postoperative cerebral embolism in properly selected cardiac surgery patients undergoing routine preoperative CTA examination.