Commentary to JOCS-2021-OA-0579

Surgical implantation of a complete or incomplete ring to reduce the valve annulus and improve leaflet coaptation is the mainstay of mitral valve surgery. The Cardioband® system (Edwards Lifesciences, Irvine, CA, USA) was designed to address the pathophysiological mechanism of annular dilatation through a catheter-based approach. We present the histopathological workup of a Cardioband® device, which had been implanted 21 months earlier in a 34-year-old male with ischemic cardiomyopathy. Device examination demonstrate a well-positioned and securely anchored device. The described tissue reactions may have an impact on choice of device and timing in case of re-do surgery.

Commentary to JOCS-2020-RA-1888

Here we report the seven-year long-term survival after Aspergillus fumigatus mediastinitis after heart transplantation, an uncommonly described condition. A 66-year-old male developed infection with A. fumigatus covering the entire thoracic cavity with a fungal turf after orthotopic heart transplantation. Repeated surgical removal of infectious and necrotic tissue together with innovative topical treatment using voriconazole and chlorhexidine combined with systemic antifungal treatment lead to control of infection. Definitive wound closure was achieved by standard sternal refixation and latissimus dorsi muscle flap plasty. Survival after A. fumigatus mediastinitis after heart transplantation was achieved with sequential debridement in combination with topical application of antifungal agents.

Commentary to JOCS-2020-OA-1345

The current COVID-19 pandemic has a huge impact on society and economy and represents one of the biggest challenges for healthcare systems all over the world. Reports from health-care-institutions in different countries show a variety of crisis exit strategies. Although experiences in handling of the pandemic have accumulated over the last 7 months, it is clear that measures to prevent a collapse of the health-care-systems have to be adapted to local political and socioeconomic structures. The aim of this review is to give insight in crisis exit strategies in Switzerland, highlighting the role and impact of COVID-19 in the field of cardiac surgery.

Fungal osteomyelitis is uncommon after cardiac surgery. A case of Candida albicans and S. epidermidis osteomyelitis with device infection after implantation of a left ventricular assist device in a male patient is presented. After confirmation with microbiological and radiological examinations, debridement was performed. Surgical specimens grew C. albicans and S. epidermidis. Fluconazole, daptomycin and negative pressure wound therapy failed to achieve healing. Total sternectomy and pectoralis muscle flap reconstruction were performed. There was no recurrent infection for C. albicans on a prolonged antifungal regime. The combination of antifungal therapy and aggressive surgical debridement may be useful to control fungal osteomyelitis.

COVID-19 hit hard worldwide. There has been an impact on global activity of cardiac surgery. Spain has been one of the hardest hit countries with one of the highest per population incidences and death. Cardiac surgical activity has suffered a negative impact all over the country. The following is an overview of the epidemiology and impact on resources, the caseload and surgical societal implemented recommendations, the description of the ECMO activity and nosocomial transmission among healthcare workers.

Tricuspid regurgitation progression after left-sided surgery and its correlation with worse postoperative and long-term outcomes is a highly debated topic. Some studies support prophylactic tricuspid repair based on annulus dimension rather than on tricuspid regurgitation severity only, while others are in favor of more conservative management. Furthermore, the advent of percutaneous tricuspid valve intervention and its promising short-term outcomes has introduced a new factor to be taken into account on the tricuspid intervention decision-making process. We present a review on prophylactic tricuspid valve intervention, covering currently available data, as well as the role of transcatheter tricuspid valve intervention in this equation.