ABSTRACT
BACKGROUND: The aim of the current study was to assess the effects of total arterial myocardial revascularization (TAMR) with bilateral internal mammary arteries. MATERIAL AND METHOD: 139 consecutive patients who underwent off pump coronary artery bypass surgery from January 2000 to December 2001 were included in the current retrospective study. Patients were divided into those receiving bilateral internal mammary artery, BITA (n=85) and those receiving single internal mammary artery, SITA (n=54). RESULT: There was only one death in each group. No significant differences were noted in the total ICU and hospital stay; 2.4+/-1.7 and 11.2+/-17.7 days, in the BITA group, respectively and 2.8+/-2.7 and 9.7+/-7.1 days in the SITA group, respectively (P>0.05). The mean number of distal anastomosis of 3.9+/-0.7 was slightly higher in the BITA group compared to the SITA group, which was 3.1+/-0.8. Myocardial infarction occurred in 7 patients (BITA group: 2, SITA group: 5) and deep sternal infection necessitating reoperation occurred in 4 patients (BITA group: 3, SITA group: 1). Coronary angiogram was performed in the immediate postoperative period in 104 patients (BITA group: 64/85, SITA group: 40/54). Of these patients, stenosis in the LAD anastomosis site occurred in 4 patients (BITA group: 2, SITA group: 2). A total of 8 anastomotic sites were stenotic in the entire series of which percutaneous intervention was performed in 3 patients and none required reoperative coronary artery bypass. CONCLUSION: The results of the current data did not show a significant difference in patency rate with bilateral internal mammary artery use for CABG supporting the feasibility of its use as a viable alternative method for TAMR.
Subject(s)
Humans , Constriction, Pathologic , Coronary Artery Bypass , Coronary Artery Bypass, Off-Pump , Length of Stay , Mammary Arteries , Myocardial Infarction , Myocardial Revascularization , Postoperative Period , Reoperation , Retrospective Studies , Skeleton , Minimally Invasive Surgical Procedures , TransplantsABSTRACT
BACKGROUND: The present study was undertaken to assess the effectiveness of surgical repair as a method of treatment for rheumatic mitral regurgitation by comparing the results of mitral valvuloplasty(MVP) in rheumatic mitral regurgitation and degenerative mitral regurgitation. MATERIAL AND METHOD: Among the 184 MVP patients between January 1995 to December 1998, 49 Rheumatic mirtal regurgiation patients(Group I) and 72 degenerative mirtal regurgitation(Group II) patients were studied. The mean age in group I was 36.3+/-14.6(16-74) and in group II, 52.5+/-13.4(14-77) years. The total follow up duration was 72.2patient years for group I and 77.2 patient years for group II. The Echocardiography was performed preoperatively, at 6months and 1 year postoperatively, and then yearly thereafter in both groups. RESULT: Preoperatively, there were no hemodynamic differences between the two groups. The preoperative mitral regurgitation was 3.9+/-0.4 in group I and 3.9+/-0.3 in group II, but on follow up, both groups showed decrease of grade of regurgitation to 0.9+/-0.9 in group I and 0.8+/-0.7 in group II. The mitral valve area or the mean transmitral pressure gradient was not significantly different between the two groups. There was neither early nor late mortality in either group and the reoperation rate in group I was 1.4% per patient year and 2.6% per patient year in group II. The rate of thromboembolism in group I was 2.8% per patient year and 1.3% per patient year in group II. There was one bacterial endocarditis in group I. Statistical analysis of the data between the two groups failed to reveal any significant differences. CONCLUSION: Although the results of a long term follow up will be required, the current intermedite term study showed that repair was a viable option in the treatment of rheumatic mitral regurgitation.
Subject(s)
Humans , Echocardiography , Endocarditis, Bacterial , Follow-Up Studies , Hemodynamics , Mitral Valve , Mitral Valve Insufficiency , Mortality , Reoperation , Rheumatic Heart Disease , ThromboembolismABSTRACT
BACKGROUND: The current study was undertaken to investigate the results of a modification in the conventional Maze III Procedure devised by the authors. The aim of the technical modification was in improving the left atrial contractility. MATERIAL AND METHOD: Between July 1997 and December 1998, 34 patients with chronic atrial fibrillation for more than 1 year duration underwent a modified Maze III procedure. The assessment of the left atrial function was made by various echocardiographic measurements and SA nodal recovery was evaluated by HRV Holter monitoring. RESULT: All 34 patients were in sinus rhythm. On echocardiography, right atrial contraction was detected in 32 patients(94.1%) and left atrial contraction in 33 patients(97.1%). The echocardiographic A wave at 1, 6, and 12 months or more were 50.5+/-31.5, 62.1+/-25.1, 66+/-20.6 cm/sec, respectively, and the E wave measurements at the same time points were 152+/-31.1, 134.4+/-35.2, 133+/-27.5 cm/sec. The corresponding A/E ratios were 0.32+/-0.13, 0.48+/-0.18, 0.5+/-0.15, showing a rising trend. Treadmill evaluation at 6 months showed a mean 82% increase in heart rate after excising, and the SDNN and SDANN upon HRV Holter at 1 and 3 months postoperatively were 65.3+/-28.1/87.8+/-27.2 ms, and 60.0+/-24.1/83.4+/-25.7 ms, respectively, showing a predoinant autonomic recovery in the parasympathetic system(PSDNN = 0.01, PSDANN =0.015). CONCLUSION: The results of our data suggest that the current modification in the conventional Maze III Procedure was efective in enhancing the postoperative left atrial contractility.