European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
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Eur J Cardiothorac Surg · Oct 2013
Late effects of radial artery vs saphenous vein grafting for multivessel coronary bypass surgery in diabetics: a propensity-matched analysis.
To determine whether the use of the radial artery (RA) vs the saphenous vein (SV) as the second grafting conduit with the internal thoracic artery (ITA) confers a late-survival advantage in diabetes mellitus (DM). ⋯ Our analysis indicated that RA grafting confers a significant late-survival advantage and, thus, supports its liberal use in DM patients undergoing multivessel CABG.
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Eur J Cardiothorac Surg · Oct 2013
Is rheumatic aetiology a predictor of poor outcome in the current era of mitral valve repair? Contemporary long-term results of mitral valve repair in rheumatic heart disease.
Contemporary experience with mitral valve (MV) repair in the rheumatic population is limited. We aimed to examine the long-term outcomes of rheumatic MV repair, to identify the predictors of durability and to compare the repair for rheumatic and degenerative MVs. ⋯ The durability of MV repair for rheumatic disease in the current era has improved and is comparable with the outstanding durability of repairs for degenerative disease. Modifications of standard repair techniques, adherence to the importance of good leaflet coaptation and strict quality control with stringent use of intraoperative transoesophageal echocardiography have all contributed to the improved long-term results.
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Type IIIa mitral regurgitation (MR) due to rheumatic leaflet restriction often renders valve repair challenging and may predict a less successful repair. However, the utilization of leaflet mobilization and extension with the pericardium to increase the surface of coaptation may achieve satisfactory results. We reviewed our experience with leaflet extension in rheumatic mitral repair with emphasis on the technique and mid-term results. ⋯ Repair with leaflet extension in rheumatic disease resulted in good early and mid-term outcomes. A wider utilization of this technique may increase the feasibility and durability of repair in complex rheumatic mitral valve disease.
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Eur J Cardiothorac Surg · Oct 2013
Comparative StudyRevascularization in left main coronary artery disease: comparison of off-pump coronary artery bypass grafting vs percutaneous coronary intervention.
There is no evidence for the increasing use of percutaneous coronary intervention (PCI) compared with surgery in patients with left main coronary artery (LMCA) disease. We compared the clinical outcomes of patients with LMCA disease who had undergone PCI with those of patients who had off-pump coronary artery bypass (OPCAB) grafting. ⋯ Compared with PCI, OPCAB is associated with a lower incidence of MACCE in patients with LMCA disease, determined mainly by the lower incidences of acute myocardial infarction and target-vessel revascularization. The incidence of stroke in the OPCAB group was similar to the PCI group.