Texas Heart Institute journal
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Case Reports
Aortic insufficiency in a patient with Marfan syndrome after aortic root reconstruction with a tailored-sinus graft.
A patient with Marfan syndrome underwent valve-preserving aortic root reconstruction with a Robicsek-Thubrikar graft. Intraoperative transesophageal echocardiography showed aortic insufficiency after extracorporeal circulation was discontinued. Placing 3 subcommissural annuloplasty sutures corrected the severe aortic insufficiency. Herein, we discuss the mechanism and prevention of aortic regurgitation after aortic root replacement with a new graft that contains pre-designed aortic sinuses.
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Case Reports
Management of intramural hematoma of the ascending aorta and aortic arch: the risks of limited surgery.
We present the case of a 57-year-old woman who had an intramural hematoma of the ascending aorta and aortic arch. After initial blood pressure control and imaging studies, the patient underwent limited surgical repair that consisted of ascending aortic replacement. ⋯ Current world medical literature regarding thoracic aortic intramural hematoma is presented. This case supports the treatment of intramural hematomas of the ascending aorta and arch by surgical replacement of both segments with a Dacron graft, with the patient under deep hypothermic circulatory arrest.
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Comparative Study Clinical Trial
Full-sternotomy off-pump versus on-pump coronary artery bypass procedures: in-hospital outcomes and complications during one year in a single center.
We prospectively compared, according to their preoperative clinical profiles, the in-hospital outcomes of patients operated on consecutively (but without randomization) for isolated coronary artery disease with on-pump or off-pump techniques. During 2001, 324 patients underwent coronary artery bypass grafting: 216 patients (mean age, 66.7 +/- 8.9 years; range, 41-85 years) underwent on-pump revascularization, and 108 patients (mean age, 676 +/- 10 years; range, 37-90 years) underwent full-sternotomy off-pump revascularization. The 2 groups were homogeneous with regard to female sex (22.6% vs 26.8%), previous cardiac operation (2.8% vs 4.6%), cardiogenic shock (1.3% vs 1.9%), diabetes (30% vs 33%), and chronic renal failure that required hemodialysis (3% vs 3.5%). ⋯ Off-pump patients showed a significantly shorter intensive care unit stay (P = 0.02), and less need for intra-aortic balloon pump insertion (P = 0.04). In-hospital mortality was 2.8% in on-pump patients and 2.7% in off-pump patients (P = NS). Although the hospital mortality rate was comparable for the 2 techniques, the in-hospital comparison between the 2 groups showed how the avoidance of cardiopulmonary bypass can significantly reduce the cumulative postoperative incidence of complications in patients undergoing coronary artery bypass grafting.