Cardiovascular surgery (London, England)
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Active aortic endocarditis is a serious condition that carries a high mortality and morbidity. The aim of this study was to analyse results obtained from 24 patients who underwent aortic valve or root replacement with cryopreserved homograft for aortic endocarditis. Eleven patients had native valve endocarditis, and 13 had prosthetic valve endocarditis. ⋯ The actuarial survival rate at 3 years was 83.4%. All survivors are symptom-free, with no evidence of recurrent endocarditis. Doppler echocardiography showed minimal aortic regurgitation in four patients.
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Comparative Study
Supraceliac versus infrarenal aortic cross-clamp for repair of non-ruptured infrarenal and juxtarenal abdominal aortic aneurysm.
Repair of abdominal aortic aneurysms may require aortic occlusion above the renal arteries. Despite fears of renal, hepatic and intestinal ischemia, recent publications have suggested that when repair would be difficult or impossible with infrarenal aortic clamping, supraceliac clamping may not be associated with significantly increased morbidity. Between February 1985 and January 1994, 169 patients underwent elective or urgent (symptomatic but not ruptured) repair of infra- or juxtarenal abdominal aortic aneurysm. ⋯ Supraceliac clamping was not associated with greater perioperative morbidity and may have contributed to a lack of mortality by facilitating repair of difficult abdominal aortic aneurysm. Supraceliac clamping should be considered for elective and urgent abdominal aortic aneurysm repair when there is inadequate length or quality of infrarenal aorta for anastomosis, severe associated pararenal atherosclerosis, inflammatory aneurysm, or previous aortic surgery. It is concluded that selective supraceliac clamping is safe and facilitates repair of difficult aortic problems.
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Management of carotid arterial injuries associated with focal neurological deficit or altered state of consciousness (SCON) remains unresolved. Experience with these injuries in one particular hospital was reviewed and the Glasgow Coma Scale (GCS) utilized to assist with clinical stratification of these patients. A literature review was also conducted to better define indications for repair or ligation of carotid injuries. ⋯ It is concluded that carotid arterial injuries should be repaired in patients with normal neurologic evaluation, focal pre-operative neurologic deficits and in patients with GCS > 9. Comatose patients with GCS < 8 do poorly regardless of management. The GCS provides an objective for stratification of patients with altered SCON who benefit from repair of carotid arterial injuries.
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The purpose of this study was to examine the changing trends in surgical management of patients with abdominal aortic aneurysms at a tertiary care teaching hospital over the past 40 years, by analysis of demographic data, perioperative variables and outcomes on all patients having abdominal aortic aneurysm surgery between 1955 and 1993. Some 1604 abdominal aortic aneurysms were assessed. The annual rate of abdominal aortic aneurysm surgery increased from 17.6 to 67.8 cases per year. ⋯ In conclusion, there was a significant decrease in mortality and morbidity associated with non-ruptured abdominal aortic aneurysm repair over the four decades studied. In addition, older patients with smaller aneurysms and more co-morbid conditions were operated on during this period. Mortality for patients operated on for ruptured abdominal aortic aneurysm repair has not changed significantly.