Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Dec 2010
Comparative StudyCombined coronary artery bypass grafting and aortic valve replacement with minimal extracorporeal closed circuit circulation versus standard cardiopulmonary bypass.
Isolated aortic valve replacement (AVR) or coronary artery bypass grafting (CABG) using minimized extracorporeal circulation (MECC) has been shown to have less deleterious effects than standard cardiopulmonary bypass (CPB). In this prospective cohort study, we evaluated and compared clinical results of combined AVR with CABG using MECC. We prospectively collected preoperative, intraoperative, postoperative and follow-up data of 65 patients who underwent combined AVR with CABG using MECC and compared these with 135 patients undergoing combined AVR with CABG using standard CPB. ⋯ They had decreased blood products requirements (P=0.004) compared to patients in the standard CPB group. No differences were noted in pulmonary complications, neurological events or mortality. We present for the first time data showing that combined AVR with CABG using MECC is feasible and provides better clinical results compared to standard CPB with regard to blood products requirements, without compromising operative morbidity or mortality.
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Interact Cardiovasc Thorac Surg · Dec 2010
Case ReportsRupture of Kommerell diverticulum after total arch replacement.
A 62-year-old man was brought to the emergency room of our hospital because of chest pain. Computed tomography revealed a right aortic arch and an aberrant left subclavian artery with Kommerell diverticulum and acute aortic dissection (Stanford type A). Total arch replacement was performed emergently through a median full sternotomy. ⋯ The patient died because of the bleeding. Autopsy findings showed a communication between the esophagus and Kommerell diverticulum. Rupture of Kommerell diverticulum and perforation of the esophagus were indicated.
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Interact Cardiovasc Thorac Surg · Dec 2010
Case ReportsTemporary epicardial pacing wire removal: is it an innocuous procedure?
The safety and efficacy of temporary pericardial pacing wires have been accepted and their use is common after cardiac operations. Complications related to pacing wire removal are unusual but it can be serious and even catastrophic. We report an unusual case of bleeding due the laceration and rent created in the saphenous vein graft wall by the metallic tip of the pacing wire at the time of pacing wire removal.
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Interact Cardiovasc Thorac Surg · Dec 2010
Quality-of-life in octogenarians one year after aortic valve replacement with or without coronary artery bypass surgery.
The increasing number of interventions for percutaneous aortic valve replacement (AVR) justify a renewed evaluation of one-year survival rates after open AVR with and without coronary artery bypass in octogenarians. Risk factors influencing mortality are compared, and the patients' quality-of-life (QoL) after one year is assessed. One hundred and fifty-four patients (102 females, 52 males) aged on average 82.9±2.5 years, who had undergone open bioprosthetic AVR with (n=80) and without (n=74) coronary artery bypass grafting (CABG) between January 2005 and December 2007 were reviewed retrospectively. ⋯ Assessment of QoL revealed a substantial improvement of physical fitness in all 126 patients. Surgery in the aortic valve without CABG is associated with a good outcome. The improvement in QoL after one year supports the decision to operate on patients older than 80 years of age.
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Interact Cardiovasc Thorac Surg · Dec 2010
Case ReportsExtended right pneumonectomy in an adult with a double aortic arch: a therapeutic dilemma.
We report the case of a 69-year-old man presenting with a primary right lung cancer and a complete double aortic arch. An extended right pneumonectomy was successfully performed and the patient remained well at the one-year follow-up. We discuss the surgical approach and the technical considerations imposed by this rare vascular abnormality.