Cardiovascular surgery (London, England)
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Since elderly patients are being referred for surgery in increasing numbers, we reviewed the clinical outcome of 459 consecutive patients aged 70 to 89 years, who had aortic valve replacement between 1993 and 2000. We subdivided the study population into three groups: in Group 1 we included patients aged 70-74 years old; in Group 2 patients aged 75-79 years old; and in Group 3 patients aged 80 years old or older. ⋯ The overall perioperative mortality rate was 7% (32 patients), without significant differences among the three groups (P=0.88). Our study confirms the good outcome of aortic valve replacement in elderly patients even in octagenarians and only concomitant CABG procedures increase the operative risk, reducing long-term survival (P<0.05).
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Recurrent carotid stenosis following standard longitudinal carotid endarterectomy (s- CEA), with and without patch angioplasty, effects the durability of the procedure and can lead to reintervention. The purpose of this study is to evaluate the incidence of restenosis following eversion carotid endarterectomy (e-CEA) in women. ⋯ The eversion technique for CEA requires both the transection and anastomosis of the internal carotid artery at the carotid bulb, and appears to result in a low incidence of restenosis in women. This is a straightforward technique and obviates the need for primary closure of distal smaller caliber internal carotid artery that can lead to narrowing, and the use of patch closure that has its attendant risks.
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Patients with significant risk factors are at increased risk of higher mortality and morbidity (9-16%) after CABG-procedures with cardiopulmonary bypass (CPB). When catheter interventions are not applicable and conventional CABG with CPB are considered to have an unacceptable perioperative risk, these patients (n=35) were scheduled for minimally invasive coronary artery bypass grafting (MIDCAB). ⋯ In high-risk patients, with an increased likelihood of perioperative morbidity and mortality, the MIDCAB procedure can be performed accurately and safely. Even after incomplete revascularization of some high-risk patients, exercise tolerance was improved. Transthoracic Doppler echocardiography proved to be a clinically useful noninvasive method of assessing IMA graft function at rest and during exercise. Despite the small patient population, our late follow-up results suggest the potential benefit of MIDCAB for patients with otherwise inoperable heart disease.
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Historical Article
Commentary: Surgical treatment of aortic aneurysm: 50-some years later.