European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
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Eur J Cardiothorac Surg · Jan 1995
Case ReportsOutflow tract obstruction after mitral valve repair without an annuloplasty ring.
We report that systolic anterior motion of the mitral valve with significant left ventricular outflow tract obstruction can occur after mitral valve reconstruction without using an annuloplasty ring. A 69-year-old male patient with mitral regurgitation and ischemic heart disease underwent combined mitral valve reconstruction without an annuloplasty ring, and coronary artery bypass grafting. Intraoperative transesophageal echocardiography performed at the end of the operation revealed systolic anterior motion of the mitral valve with significant outflow tract obstruction requiring a second pump run with return to cardiopulmonary bypass and additional mitral valve replacement during the same thoracotomy.
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Eur J Cardiothorac Surg · Jan 1995
Case ReportsLeg ischaemia following bilateral internal thoracic artery and inferior epigastric artery harvesting.
There is increasing evidence that the use of arterial conduits for coronary artery bypass grafting provides superior long-term results when compared to using saphenous veins alone. Major complications of using internal thoracic arteries (ITAs) and inferior epigastric arteries (IEAs) are uncommon. ⋯ The enormous size of these conduits found at operation suggested their role. Management strategies to avoid such a serious complication are discussed.
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A 90 degree bent two-stage venous cannula for cardiopulmonary bypass is presented and discussed. Its main advantages, compared to similar straight ones, are that it is out of the way of the surgeon, by being placed under the right sternum and also that the venous return seems uninfluenced by displacement of the heart when operating on the posterior side of the heart. No major drawbacks for the cannula have been noticed so far.
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Eur J Cardiothorac Surg · Jan 1995
Comparative StudyThe effect of pathophysiology on the surgical treatment of ischemic mitral regurgitation: operative and late risks of repair versus replacement.
Operative correction of ischemic mitral regurgitation (IMR) is associated with high risk approach. The objective of this retrospective study was to examine the interaction between the various underlying pathophysiologic mechanisms, the operative procedure, and their influence on short- and long-term outcomes. Over a 10-year period starting January 1984, mitral valve repair or replacement was performed on 150 patients with IMR. ⋯ The functional subset of IMR who had a repair had the worse long-term survival (43 +/- 13%) compared to the structural/repair (76 +/- 13%) and structural/replacement groups (89 +/- 8%), and 92 +/- 7% for the functional/replacement group ((P = 0.0049). Multivariate logistic regression analysis identified the functional/repair group (hazards ratio 4.4; +/- 95%, confidence interval 1.6, 11, (P = 0.0031); and earlier years of surgery (hazards ratio 4.7; +/- 95% confidence interval 1.021; (P = 0.046) to be predictors of worse long-term survival. These results suggest that, in IMR, the underlying responsible pathophysiologic mechanisms appear to be the major determinants of survival, rather than the choice of the operative procedure.
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Eur J Cardiothorac Surg · Jan 1995
Comparative StudySurgery for acute ascending aortic dissection: closed versus open distal aortic repair.
One hundred twelve consecutive patients with acute ascending aortic dissection and submitted to immediate surgery were retrospectively analyzed with regard to perioperative mortality and morbidity. The patients were divided into two groups according to whether distal aortic repair was carried out by the open procedure (using deep hypothermic circulatory arrest, group A: 68 patients) or by the closed technique (without circulatory arrest, group B: 44 patients). Patients' ages ranged from 24 to 78 years (mean 57.4 years). ⋯ The trend towards a higher mortality in group A mainly reflected the more severe and complex anatomical characteristics and could not be attributed to the circulatory arrest per se. The period of deep hypothermic circulatory arrest in the survivors (25 min) was similar to that of the group with lethal outcome (32 min). Among the non-lethal complications, however, group A patients more frequently showed clinical signs consistent with cerebral injury: apart from the transient symptoms suggestive in reversible diffuse cerebral damage, five patients in group A had a permanent focal neurological deficit (versus one patient in group B).(ABSTRACT TRUNCATED AT 250 WORDS)