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 1996
Aortic root replacement with a composite graft. Factors influencing immediate and long-term results.
From April 73 to June 94, 203 patients (167 men, 36 women) aged from 10 to 74 years (mean: 44.8 +/- 15) underwent ascending aortic replacement with composite graft for: dystrophic aneurysm (AN) (130 cases, 64.5%), chronic dissection (CD) (35 cases, 17.2%), type A acute dissection (AD) (38 cases, 18.7%). Forty-six patients (22.6%) suffered from Marfan syndrome (24 AN, 13 AD, 9 CD). Thirty patients (14.7%) had undergone a previous cardiac or aortic operation. ⋯ The technique of coronary reimplantation has a significant influence on the long-term results. The reimplantation of choice is the "button" technique, especially in the presence of a fragile aortic wall (AD). The "Cabrol" technique must be used when the "button" or the "Bentall" reimplantation is not feasible, for instance during redo procedures.
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Eur J Cardiothorac Surg · Jan 1996
Respiratory muscle strength after lung resection with special reference to age and procedures of thoracotomy.
Changes in respiratory muscle strength after lung resection were examined concerning age and procedures of thoracotomy. Maximum inspiratory (MIP) and expiratory (MEP) mouth pressure were measured before operation and 1, 2, 4, and 12 weeks after operation in 81 patients undergoing lung resection. In 48 patients undergoing pneumonectomy, lobectomy, or segmentectomy, patients older than 70 showed a significantly lower MIP and MEP before operation and throughout the postoperative period compared to younger ones (P < 0.01). ⋯ In 31 patients undergoing lung wedge resection, patients undergoing limited thoracotomy (LT) and video-assisted thoracic surgery (VATS) showed significantly higher percentages of postoperative MIP and MEP than those undergoing posterolateral thoracotomy (PLT) 1 and 2 weeks after operation (P < 0.01 or 0.05). But there was no significant difference in the values between LT and VATS. We concluded that (1) elderly patients suffered respiratory muscle weakness before and after operation and their postoperative recovery of respiratory muscle strength was slower than in younger patients, and (2) VATS and LT resulted in more rapid recovery of respiratory muscle strength than PLT, but the difference between VATS and LT was not significant.
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Since 1990 the Institute of Cardiac Survey has compiled data on open heart surgery. In 1993 247,943 operations were performed. ⋯ This subset was 1.9%, e.g. 4,689, of the total number. The increasing rate of open heart surgery in Europe was 8.3%, whereby the highest increasing rate could be observed in CABG.
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Eur J Cardiothorac Surg · Jan 1996
Taussig-Bing anomaly and arterial switch: aortic arch obstruction does not influence outcome.
Aortic arch obstruction is a commonly associated problem in the Taussig-Bing anomaly. Between 1983 and 1995, 28 consecutive patients with Taussig-Bing anomaly underwent arterial switch operation with baffling of the left ventricle to neoaorta. Group A: 11/28 had associated aortic arch obstruction. Group B: 17/28 had isolated Taussig-Bing anomaly. We assessed whether the coexistence of subpulmonary ventricular septal defect and aortic arch obstruction pose an incremental risk factor. ⋯ 1. Aortic arch obstruction has not adversely affected early or late survival (P>.05) or late functional class. 2. Patients with Taussig-Bing anomaly and aortic arch obstruction may have a higher reoperation rate than those with normal arch anatomy. 3. Taussing-Bing anomaly, with or without aortic arch obstruction, can be repaired with arterial switch operation during the neonatal period with good outcome.
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Open chest (OC) and subsequent delayed sternal closure (DSC) has been described as a useful method in the treatment of the severely impaired heart after cardiac surgery. ⋯ This study shows that OC with DSC is a beneficial adjunct in the treatment of postoperatively impaired cardiac function, profuse hemorrhage and persistent arrhythmias. It can be performed without increased sternal morbidity. Long-term results are also encouraging.