ABSTRACT
Background: This study was designed to determine the short- and long-term effects of proximal aortic anastomosis, performed during isolated coronary artery bypass grafting (CABG) in patients with dilatation of the ascending aorta who did not require surgical intervention.Methods: The study was performed on 192 (38 female and 160 male patients; mean age, 62.1 ± 9.2 years; range, 4280 years) patients with dilatation of the ascending aorta who underwent CABG surgery between 1 June 2006 and 31 May 2014. In group 1 (n = 114), the saphenous vein and left internal mammarian artery grafts were used, and proximal anastomosis was performed on the ascending aorta. In group 2 (n = 78), left and right internal mammarian artery grafts were used, and proximal aortic anastomosis was not performed. Pre-operatively and in the first and third years postoperatively, the ascending aortic diameter was measured and recorded using transthoracic echocardiography at four different regions (annulus, sinus of Valsalva, sinotubular junction and tubular aorta).Results: A statistically significant difference was found between the groups for the number of grafts used and the duration of aortic cross-clamping and cardiopulmonary bypass. No significant intergroup difference was seen for the mean diameter of the ascending aorta (p > 0.05). Annual changes in the aortic diameter were found to be extremely significantly different in both groups (p = 0.0001). Mean values of the aortic diameter at the level of the sinotubular junction and tubular ascending aorta, mean aortic diameters (p = 0.002 and p = 0.0001, respectively), annual increase in diameter (p = 0.0001 and p = 0.0001, respectively), and mean annual difference in diameter (p = 0.0001 and p = 0.0001, respectively) at one and three years postoperatively were statistically significantly different between the groups.Conclusion: In patients with ascending aortic dilatation who did not require surgical intervention and who had proximal anastomosis of the ascending aorta and underwent only CABG, we detected statistically significant increases in the diameter of the sinotubular junction and tubular aorta up to three years postoperatively
Subject(s)
Anastomosis, Surgical , Aorta , Coronary Artery Bypass , Diagnostic Techniques, Surgical , Prospective Studies , South AfricaABSTRACT
Background/Objective: Spinal fusion is a rapidly developing area of spine surgery. Many of the implants often used are not within the reach of the patients in the developing world. In this study; we describe the outcome of a novel technique of posterior spinal fusion using the rush nail and spinous process wire. Materials and Methods: We prospectively evaluated patients who underwent the technique since October 2006. We reviewed the patients' biodata; clinical diagnosis; imaging studies; indications for surgery; type of operations; and complications related to the implants and the technique. Clinical test of instability was also determined. Results: The technique was used in 11 female and 19 male patients. The age range was 11-82 years. The indication for surgery was trauma in 15 patients; degenerative disease in seven patients; tuberculosis of the spine in four patients; and four patients had neoplasms. Occipitocervical fusion was performed in three patients; cervical fusion in six patients; thoracic fusion in 10 patients; thoracolumbar fusion in seven patients; lumbar fusion in three patients; and lumbosacral fusion in one patient. The distal segment of the implant backed out in one patient following fracture of the spinal process. The implant was eventually removed. Clinical evidence of instability necessitating external orthotics was also seen in one patient. Two patients had wound infection. These were managed without removing the implants. We did not observe significant complications in other patients. Conclusion: The technique appears safe and effective in carefully selected cases. The technique needs further evaluation in a larger patient population and with a longer duration of follow-up