European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
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Eur J Cardiothorac Surg · Feb 2014
No ring at all in mitral valve repair: indications, techniques and long-term outcome.
In mitral valve (MV) repair, we adhere to a biological concept of preservation of the native valves and avoidance of any prosthetic materials except for sutures whenever possible. Untreated autologous pericardium is the biological tissue of choice we use to support the repair. We report our 25-year institutional experience with no-ring MV repair in terms of indications, repair techniques and long-term results. ⋯ No-ring MV repair using the aforementioned techniques in patients with MI resulting from chordal rupture, degenerative valve disease, IE, annular dilatation and posterior leaflet prolapse and from IMI as well as various MV lesions in children offers excellent long-term functional results with satisfactory freedom from reoperation.
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Eur J Cardiothorac Surg · Feb 2014
Impact of afterload reduction strategies on regional tissue oxygenation after the Norwood procedure for hypoplastic left heart syndrome.
Low cerebral tissue oxygenation saturations have been observed by near-infrared spectroscopy (NIRS) after the Norwood procedure. Altered cerebral vascular resistance and pharmacological afterload reduction redirecting blood flow away from the cerebral circulation are possible mechanisms. ⋯ The postoperative decline of cerebral tissue oxygen saturation was observed with both afterload reduction strategies. The difference between cerebral and somatic NIRS values may indicate a mismatch between cerebral and splanchnic oxygenation. Other strategies to improve cerebral tissue oxygenation are warranted.
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Eur J Cardiothorac Surg · Feb 2014
Observational StudyResults of rapid-response extracorporeal cardiopulmonary resuscitation in children with refractory cardiac arrest following cardiac surgery.
Survival of children having cardiac arrest refractory to conventional cardiopulmonary resuscitation (CPR) is very poor. We sought to examine current era outcomes of extracorporeal CPR (ECPR) support for refractory arrest following surgical correction of congenital heart disease. ⋯ ECPR plays a valuable role in children having refractory postoperative cardiac arrest. Survival is unrelated to cardiac physiology or surgical complexity. Timely support prior to the emergence of end-organ injury and surgical correction of residual cardiac lesions might enhance survival.
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Eur J Cardiothorac Surg · Feb 2014
Early and mid-term outcomes of combined aortic valve replacement and coronary artery bypass grafting in elderly patients.
Although the number of elderly patients undergoing combined aortic valve replacement (AVR) and coronary artery bypass grafting (CABG) is increasing, the early and mid-term outcomes of this combined procedure remain to be determined. We sought to elucidate the early and mid-term outcomes of elderly (≥75 years) vs non-elderly (<75 years) patients who underwent combined AVR and CABG. ⋯ Early and mid-term outcomes of combined AVR and CABG were similar between elderly and non-elderly patients. Older age was not a risk factor for mortality in patients undergoing combined AVR plus CABG, and this procedure should be recommended in properly selected elderly patients.