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2.
Thorac Cardiovasc Surg ; 66(6): 483-490, 2018 09.
Article in English | MEDLINE | ID: mdl-29510430

ABSTRACT

BACKGROUND: We aimed to investigate the risk factors of post-coronary artery bypass grafting (CABG) atrial fibrillation (AF) in male and female patients without any history of AF, to identify the sex-specific risk factors, and to examine the effect of sex-specific risk factors on the overall population. METHODS: This retrospective study was conducted using the hospital database with 4,758 patients who underwent CABG surgery. Among them, 2,836 patients with complete data participated in this study. The female patients were divided into two groups as patients who developed new-onset AF after CABG and those who did not. The relationship between the patients' variables and risk factors of post-CABG AF was examined. RESULTS: The overall incidence of post CABG AF was 12.9% (386/2,836). Sex-specific incidence of AF was similar: 3.2% (91/690) and 12.9% (277/2146) in female and male patients, respectively (p = 0.849). Multiple analysis revealed the independent risk factors for male and female patients, respectively: mean age (odds ratio [OR] = 1.057, OR = 1,076), age over 65 years (OR = 2.156, OR = 2.736), the European System For Cardiac Operative Risk Evaluation Scores (EuroSCORE) (OR = 1.13, OR = 1.218), COPD (OR = 1.589, OR = 1.789), BUN level (OR = 1.026, OR = 1.019), mean cardiopulmonary bypass (CPB) time (OR = 1.007, OR = 1.010), prolonged CPB time (OR = 1.604, OR = 2.309), mean cross-clamp time (OR = 1.009, OR = 1.017), need of inotropic support (OR = 2.249, OR = 2.731), and mean mechanical ventilation time (VT) (OR = 1.026, OR = 1.027).Low left ventricular ejection fraction (LVEF) (OR = 1.419), left ventricular (LV) aneurysm repair (OR = 1.533), carotid artery disease (OR = 1.750), prolonged VT (OR = 1.729), and use of intra-aortic balloon pump (IABP) (OR = 2.436) were found to be the risk factors only for male AF patients.Unstable angina (OR = 1.969), right coronary artery (RCA) disease (OR = 2), prolonged cross-clamp time (OR = 2.152), and the number of grafts per operation (OR = 1.298) were found to be the risk factors only for female AF patients. CONCLUSION: This study suggests that predictors of AF in the overall population may be due to isolated patient groups. Multiple regression analysis and artificial intelligence modelling should be performed on large-scale, isolated groups to make strong AF prediction.


Subject(s)
Atrial Fibrillation/epidemiology , Coronary Artery Bypass/adverse effects , Coronary Artery Disease/surgery , Adult , Aged , Atrial Fibrillation/diagnosis , Atrial Fibrillation/physiopathology , Comorbidity , Coronary Artery Disease/diagnosis , Coronary Artery Disease/epidemiology , Coronary Artery Disease/physiopathology , Databases, Factual , Female , Health Status Disparities , Humans , Incidence , Male , Middle Aged , Odds Ratio , Retrospective Studies , Risk Factors , Sex Distribution , Sex Factors , Time Factors , Treatment Outcome , Turkey/epidemiology
3.
Ann Thorac Surg ; 103(1): e65-e67, 2017 Jan.
Article in English | MEDLINE | ID: mdl-28007278

ABSTRACT

Hyperimmunoglobulin E syndrome (HIES) is an immunodeficiency disorder that manifests itself by affecting more than one system. Arterial aneurysms are among the significant complications associated with HIES. Surgical procedures for patients with such aneurysms are uncommon. In this study, we aim to present the case and surgical repair of a male child who was previously diagnosed with HIES and presented with rapidly expanding ascending aortic aneurysm.


Subject(s)
Aortic Aneurysm, Thoracic/surgery , Job Syndrome/complications , Vascular Surgical Procedures/methods , Aortic Aneurysm, Thoracic/diagnosis , Aortic Aneurysm, Thoracic/etiology , Child , Echocardiography , Humans , Job Syndrome/surgery , Male , Tomography, X-Ray Computed
4.
Turk J Med Sci ; 46(4): 1162-7, 2016 Jun 23.
Article in English | MEDLINE | ID: mdl-27513420

ABSTRACT

BACKGROUND/AIM: To investigate the effects of pulmonary hypertension on early clinical variables in patients undergoing coronary artery bypass grafting surgery. MATERIALS AND METHODS: The preoperative echocardiographic data of patients who underwent isolated coronary artery bypass surgery were evaluated retrospectively. A total of 1244 patients were included in the study. The patients were divided into two groups: one group consisted of patients with systolic pulmonary artery pressure (SPAP) values equal to or greater than 30 mmHg (Group 1, n = 184), while the other group consisted of patients with SPAP values below 30 mmHg (Group 2, n = 1060). RESULTS: Early mortality was similar in both groups (0% in Group 1 and 1.2% in Group 2; P > 0.05). Comparison of postoperative data indicated that Group 1 had a higher need for inotropic agent treatment, a longer average duration of ventilation, and a longer average duration of stay in the intensive care unit (P < 0.05). For the other variables, no significant differences were identified between patients with and without pulmonary hypertension (P > 0.05). CONCLUSION: Mild pulmonary hypertension (mean SPAP = 37.7 ± 8.4 mmHg) was not associated with a significant difference in the mortality of patients undergoing coronary artery bypass grafting. For patients undergoing this type of coronary bypass surgery, lower morbidity and mortality rates can be achieved through comprehensive preoperative examinations and effective perioperative medical procedures.


Subject(s)
Hypertension, Pulmonary , Coronary Artery Bypass , Humans , Inpatients , Postoperative Complications , Retrospective Studies , Risk Factors , Treatment Outcome
5.
Ann Thorac Cardiovasc Surg ; 21(3): 268-74, 2015.
Article in English | MEDLINE | ID: mdl-25753326

ABSTRACT

PURPOSE: We aimed to evaluate the effects of preoperative pulmonary hypertension (PH) on early and long term results in patients undergoing coronary bypass surgery and the effects of coronary bypass surgery on PH. METHODS: Among 2325 patients who underwent elective isolated coronary artery bypass surgery between March 2003 and March 2012, 287 patients with high preoperative pulmonary arterial pressure (PAP) ≥30 mmHg were examined. Patients' data were obtained by retrospective examination of our clinic's database. 69 patients who had complete parameters included in the study. RESULTS: There was no increase in the New York Heart Association (NYHA) functional classification 84% of cases. Preoperative and postoperative values of the mean ejection fraction and mean PAP of patients was respectively 45.28 ± 9.67 (25-65), 46.03 ±12.4 (20-65) (p = 0.447), 36.67 ± 6.81 (30-60) mmHg, 37.81 ± 10.07 (20-70) mmHg (p = 0.378). The late mortality of cases was 5.79%. In our study, during 33.9 ± 17 (9-100) months follow up period, life expectancy was calculated as 94.7 months. CONCLUSION: Preoperative evaluation of these patients for appropriate medical treatment at peroperative and postoperative period, coronary bypass can be performed with low morbidity and mortality rates. In the late period after surgical revascularization PH showed no significant change and had no adverse effect on quality of life.


Subject(s)
Coronary Artery Bypass , Coronary Artery Disease/surgery , Hypertension, Pulmonary/complications , Aged , Arterial Pressure , Coronary Artery Bypass/adverse effects , Coronary Artery Bypass/mortality , Coronary Artery Disease/complications , Coronary Artery Disease/diagnosis , Coronary Artery Disease/mortality , Coronary Artery Disease/physiopathology , Elective Surgical Procedures , Female , Humans , Hypertension, Pulmonary/diagnosis , Hypertension, Pulmonary/mortality , Hypertension, Pulmonary/physiopathology , Kaplan-Meier Estimate , Life Expectancy , Male , Middle Aged , Pulmonary Artery/physiopathology , Quality of Life , Retrospective Studies , Risk Factors , Time Factors , Treatment Outcome
6.
Rev. bras. cir. cardiovasc ; 29(4): 581-587, Oct-Dec/2014. tab
Article in English | LILACS | ID: lil-741736

ABSTRACT

Objective: Postoperative atrial fibrillation is a common complication after cardiac surgery, with an incidence as high as 20-50%. Increased age is associated with a significant increase in postoperative atrial fibrillation risk. This common complication is associated with higher morbidity and mortality rates. The aim of this study was to assess the efficacy of nebivolol in preventing atrial fibrillation following coronary artery bypass surgery in patients over 60 years of age. Methods: In this prospective randomized study, 200 patients who were candidates for elective coronary artery bypass surgery were divided into two groups. The first group was administered with nebivolol and the second group was administered with metoprolol. Treatment was initiated four days prior to surgery, and patients were monitored for atrial fibrillation until discharge. Forty-one patients recieved 50 mg metoprolol succinate daily, which was initiated minimum 4 days before surgery. Results: Demographic data were similar in both groups. The incidence of postoperative atrial fibrillation in both groups was similar, with no significant difference being identified [n=20 (20%); n=18 (18%), P=0.718; respectively]. There were not any mortality at both groups during study. Inotropic agent requirement at ICU was similar for both groups [n=12 (12%), n=18 (18%), P=0.32]. Conclusion: We compared the effectiveness of nebivolol and metoprolol in decreasing the incidence of postoperative atrial fibrillation, and determined that nebivolol was as effective as metoprolol in preventing postoperative atrial fibrillation at patients. Nebivolol may be the drug of choice due to its effects, especially after elective coronary artery bypass surgery. .


Objetivo: Pós-operatório fibrilação atrial é uma complicação comum após a cirurgia cardíaca, com uma incidência tão elevada quanto 20-50%. O aumento da idade está associado com elevação significativa no risco de pós-operatório da fibrilação atrial. Esta complicação comum é associada com taxas de morbidade e mortalidade. O objetivo deste estudo foi avaliar a eficácia do nebivolol na prevenção da fibrilação atrial após cirurgia de revascularização do miocárdio de pacientes acima de 60 anos de idade. Métodos: Neste estudo prospectivo e randomizado, duzentos pacientes candidatos à cirurgia de revascularização do miocárdio foram divididos em dois grupos. O primeiro grupo foi administrado com nebivolol e o segundo grupo, com metoprolol. O tratamento foi iniciado quatro dias antes da cirurgia, e os pacientes foram monitorados para fibrilação atrial até a alta. Quarenta e um pacientes receberam 50 mg de sucinato de metoprolol diário, que foi iniciado, no mínimo, 4 dias antes da cirurgia. Resultados: Os dados demográficos foram semelhantes nos dois grupos. A incidência de fibrilação atrial pós-operatória em ambos os grupos foi semelhante, com nenhuma diferença significativa sendo identificado [n=20 (20%); n=18 (18%), P=0,718; respectivamente]. Não houve mortalidade em ambos os grupos durante o estudo. A necessidade de agente inotrópico em UTI foi semelhante nos dois grupos [n=12 pessoas (12%), n=18 (18%), P=0,32]. Conclusão: Nós comparamos a eficácia do nebivolol e metoprolol na diminuição da incidência de fibrilação atrial no pós-operatório, e verificamos que nebivolol foi tão eficaz como metoprolol na prevenção de fibrilação atrial no pós-operatório em pacientes. Nebivolol pode ser a droga de escolha devido aos seus efeitos, especialmente depois da cirurgia revascularização do miocárdio. .


Subject(s)
Aged , Female , Humans , Male , Middle Aged , Adrenergic beta-1 Receptor Antagonists/therapeutic use , Atrial Fibrillation/prevention & control , Benzopyrans/therapeutic use , Coronary Artery Bypass/adverse effects , Ethanolamines/therapeutic use , Metoprolol/therapeutic use , Postoperative Complications/prevention & control , Age Factors , Anti-Arrhythmia Agents/therapeutic use , Atrial Fibrillation/drug therapy , Nebivolol , Postoperative Period , Prospective Studies , Postoperative Complications/drug therapy , Reproducibility of Results , Risk Factors , Statistics, Nonparametric , Treatment Outcome
7.
Ann Thorac Cardiovasc Surg ; 20(2): 135-42, 2014.
Article in English | MEDLINE | ID: mdl-23445806

ABSTRACT

PURPOSE: This study aimed to establish the role of risk factors in the etiology of postoperative atrial fibrillation (AF) after coronary artery bypass grafting (CABG). METHODS: Between September 2001 and March 2008, 1040 patients underwent isolated CABG at our clinic. Nine hundred and eleven of these patients did not have any AF(Non-AF Group) and the other one hundred and twenty-nine had AF (AF Group). A retrospective study was performed for patient, disease and treatment related factors and multivariate analysis was used to identify independent clinical predictors of postoperative AF. RESULTS: Postoperative AF was identified in 129 (12.4%) of the patients, and those were significantly older and had significantly higher additive EuroSCORE score as compared with patients without AF. During the postoperative course, patients with postoperative AF also had significantly higher and prolonged (≥6 hours) mechanical ventilation time, longer and prolonged intensive care unit stay and longer hospital stay. Logistic regression analysis revealed that postoperative AF development ratio was 1.690 times higher when the ventilation time was over 6 hours (OR 1.690, 95% CI 1.092-2.615, p = 0.018); 1.240 times higher in the presence of elevated additive EuroSCORE score (OR 1.240, 95% CI1.109-1.385, p = 0.0001); 1.052 times higher in the presence of advanced age (OR 1.052,95% CI 1.031-1.0741, p = 0.0001). CONCLUSION: Analysis of our data reveals that, patient's age, additive EuroSCORE score, and prolonged ventilation are predictors of postoperative AF. Identification of risk factors might lead to better prevention of this problem and its potential consequences. However, to support our investigation and obtain more reliable evidence, prospective randomized controlled trials are needed.


Subject(s)
Atrial Fibrillation/etiology , Cardiopulmonary Bypass/adverse effects , Coronary Artery Bypass/adverse effects , Respiration, Artificial/adverse effects , Age Factors , Aged , Female , Humans , Intensive Care Units , Length of Stay , Logistic Models , Male , Middle Aged , Multivariate Analysis , Odds Ratio , Retrospective Studies , Risk Assessment , Risk Factors , Time Factors , Treatment Outcome
8.
Rev Bras Cir Cardiovasc ; 29(4): 581-7, 2014.
Article in English | MEDLINE | ID: mdl-25714213

ABSTRACT

OBJECTIVE: Postoperative atrial fibrillation is a common complication after cardiac surgery, with an incidence as high as 20-50%. Increased age is associated with a significant increase in postoperative atrial fibrillation risk. This common complication is associated with higher morbidity and mortality rates. The aim of this study was to assess the efficacy of nebivolol in preventing atrial fibrillation following coronary artery bypass surgery in patients over 60 years of age. METHODS: In this prospective randomized study, 200 patients who were candidates for elective coronary artery bypass surgery were divided into two groups. The first group was administered with nebivolol and the second group was administered with metoprolol. Treatment was initiated four days prior to surgery, and patients were monitored for atrial fibrillation until discharge. Forty-one patients received 50 mg metoprolol succinate daily, which was initiated minimum 4 days before surgery. RESULTS: Demographic data were similar in both groups. The incidence of postoperative atrial fibrillation in both groups was similar, with no significant difference being identified [n=20 (20%); n=18 (18%), P=0.718; respectively]. There were not any mortality at both groups during study. Inotropic agent requirement at ICU was similar for both groups [n=12 (12%), n=18 (18%), P=0.32]. CONCLUSION: We compared the effectiveness of nebivolol and metoprolol in decreasing the incidence of postoperative atrial fibrillation, and determined that nebivolol was as effective as metoprolol in preventing postoperative atrial fibrillation at patients. Nebivolol may be the drug of choice due to its effects, especially after elective coronary artery bypass surgery.


Subject(s)
Adrenergic beta-1 Receptor Antagonists/therapeutic use , Atrial Fibrillation/prevention & control , Benzopyrans/therapeutic use , Coronary Artery Bypass/adverse effects , Ethanolamines/therapeutic use , Metoprolol/therapeutic use , Postoperative Complications/prevention & control , Age Factors , Aged , Anti-Arrhythmia Agents/therapeutic use , Atrial Fibrillation/drug therapy , Female , Humans , Male , Middle Aged , Nebivolol , Postoperative Complications/drug therapy , Postoperative Period , Prospective Studies , Reproducibility of Results , Risk Factors , Statistics, Nonparametric , Treatment Outcome
9.
Rev Bras Cir Cardiovasc ; 28(2): 296-8, 2013 Jun.
Article in English | MEDLINE | ID: mdl-23939329

ABSTRACT

We present a case of successful repair of the mitral valve for active infective endocarditis. Mitral valve repair was performed through debridement of vegetation and abscess, resection and repair of the posterior mitral leaflet and posterior repair with autologous pericardium. Postoperative period was uneventfully, with no evidence of recurrent infection, and echocardiogram showed mitral valve competence with mild mitral regurgitation. We demonstrate that valve repair is a feasible choice in cases of active endocarditis in children.


Subject(s)
Endocarditis, Bacterial/surgery , Mitral Valve Insufficiency/surgery , Mitral Valve/surgery , Pericardium/transplantation , Child , Humans , Male , Treatment Outcome
10.
Ann Thorac Surg ; 96(1): e1-2, 2013 Jul.
Article in English | MEDLINE | ID: mdl-23816108

ABSTRACT

Currently, right axillary artery cannulation and unilateral antegrade cerebral perfusion through the same cannula are preferred choices for acute type A aortic dissection repair. However, the existence of an aberrant right subclavian artery can jeopardize cerebral perfusion through the right axillary artery cannula. In this study, we intended to explain the repair of acute type A aortic dissection using right axillary artery cannulation in a patient with aberrant right subclavian artery.


Subject(s)
Aneurysm/complications , Aortic Aneurysm, Thoracic/surgery , Aortic Dissection/surgery , Cardiovascular Abnormalities/complications , Catheterization/methods , Deglutition Disorders/complications , Vascular Surgical Procedures/methods , Aneurysm/diagnostic imaging , Aortic Dissection/complications , Aortic Dissection/diagnostic imaging , Aortic Aneurysm, Thoracic/complications , Aortic Aneurysm, Thoracic/diagnostic imaging , Axillary Artery , Cardiovascular Abnormalities/diagnostic imaging , Deglutition Disorders/diagnostic imaging , Humans , Male , Middle Aged , Subclavian Artery/abnormalities , Subclavian Artery/diagnostic imaging , Tomography, X-Ray Computed
11.
Rev. bras. cir. cardiovasc ; 28(2): 296-298, abr.-jun. 2013. ilus
Article in English | LILACS | ID: lil-682443

ABSTRACT

We present a case of successful repair of the mitral valve for active infective endocarditis. Mitral valve repair was performed through debridement of vegetation and abscess, resection and repair of the posterior mitral leaflet and posterior repair with autologous pericardium. Postoperative period was uneventfully, with no evidence of recurrent infection, and echocardiogram showed mitral valve competence with mild mitral regurgitation. We demonstrate that valve repair is a feasible choice in cases of active endocarditis in children.


Apresentamos um caso de reparo bem-sucedido da valva mitral decorrente de endocardite infecciosa ativa. Reparo da valva mitral foi acompanhado de desbridamento da vegetação e do abscesso, ressecção e plastia do folheto mitral posterior, e anuloplastia posterior com pericárdio autólogo. Pós-operatório sem evidências de infecção recorrente, e ecocardiograma demonstrou competência da valva mitral com regurgitação mitral trivial. Concluímos que o reparo valvar é uma escolha viável em caso de endocardite ativa nas crianças.


Subject(s)
Child , Humans , Male , Endocarditis, Bacterial/surgery , Mitral Valve Insufficiency/surgery , Mitral Valve/surgery , Pericardium/transplantation , Treatment Outcome
12.
Tex Heart Inst J ; 40(2): 201-3, 2013.
Article in English | MEDLINE | ID: mdl-23678224

ABSTRACT

Levoatrial cardinal vein is a rare congenital anomaly of the systemic veins. It is commonly associated with left-sided obstructive conditions such as aortic atresia, mitral atresia, and cor triatriatum. We report the case of a 14-year-old boy who was undergoing surgery for correction of a secundum atrial septal defect. Intraoperatively, we discovered that he had a levoatrial cardinal vein and no brachiocephalic vein. However, collateral vessels provided adequate flow to the right atrium, and the patient's left-sided venous pressure was not excessive, so we ligated the levoatrial cardinal vein and directly repaired the septal defect. Postoperatively, the left venous drainage was satisfactory and the patient was asymptomatic. In addition to our patient's case, we discuss the embryology, diagnosis, and treatment of levoatrial cardinal vein.


Subject(s)
Brachiocephalic Veins/abnormalities , Brachiocephalic Veins/surgery , Cardiac Surgical Procedures , Heart Septal Defects, Atrial/surgery , Vascular Malformations/surgery , Adolescent , Brachiocephalic Veins/diagnostic imaging , Brachiocephalic Veins/physiopathology , Collateral Circulation , Heart Septal Defects, Atrial/complications , Hemodynamics , Humans , Incidental Findings , Intraoperative Period , Ligation , Male , Radiography , Regional Blood Flow , Treatment Outcome , Vascular Malformations/complications , Vascular Malformations/diagnostic imaging , Vascular Malformations/physiopathology
13.
Korean Circ J ; 43(12): 842-4, 2013 Dec.
Article in English | MEDLINE | ID: mdl-24385998

ABSTRACT

Atrial septal defect (ASD) is the common congenital anomaly which requires surgical interventions. Right atrial thrombus formations after primary suture repairs of the ASD and evidences of thromboembolic complications are extremely rare. Specifically, the cases of thromboembolic complications have high mortality and morbidity risks. Two cases of giant intra-atrial thrombus formation detected in the late stage after primary repairs of ASDs are being discussed.

14.
Ann Thorac Cardiovasc Surg ; 18(6): 548-50, 2012.
Article in English | MEDLINE | ID: mdl-22572224

ABSTRACT

Anomalous origin of the left coronary artery (LCA) from the right coronary artery sinus is a rare congenital coronary anomaly. We report a case of a 48-year-old symptomatic man who was admitted to our clinic with a history of hypertension, type 2 diabetes mellitus, myocardial infarction and hypercholesterolemia. Coronary angiography was performed revealing anomalous left coronary artery from the right coronary artery sinus. In addition, stenosis of RCA and well developed stenotic diagonal artery were detected with coronary angiography. We performed coronary by-pass with left internal mammarian artery to diagonal artery and vena saphena to right coronary artery (RCA). Both coronary angiography and intraoperative view should be evaluated well in patients with anomalous of the coronary artery.


Subject(s)
Coronary Sinus/abnormalities , Coronary Vessel Anomalies/diagnostic imaging , Coronary Angiography , Coronary Artery Bypass/methods , Coronary Vessel Anomalies/surgery , Humans , Male , Middle Aged
15.
Vasc Endovascular Surg ; 44(7): 609-12, 2010 Oct.
Article in English | MEDLINE | ID: mdl-20675339

ABSTRACT

High origin ulnar artery from the brachial artery is rare and lies superficially in the forearm. Its reported frequency ranges from 0.17% to 2%. Pseudoaneurysms of peripheral arteries are very rare, and mostly these are the result of penetrating injuries. Here, we report a case pseudoaneurysm of high origin ulnar artery from the brachial artery and its surgical approach method.


Subject(s)
Aneurysm, False/etiology , Ulnar Artery/injuries , Wounds, Stab/complications , Adult , Aneurysm, False/diagnostic imaging , Aneurysm, False/surgery , Humans , Ligation , Male , Radiography , Saphenous Vein/transplantation , Treatment Outcome , Ulnar Artery/abnormalities , Ulnar Artery/diagnostic imaging , Ulnar Artery/surgery , Vascular Grafting
16.
Tex Heart Inst J ; 37(3): 301-6, 2010.
Article in English | MEDLINE | ID: mdl-20548806

ABSTRACT

We retrospectively evaluated early clinical results of coronary revascularization using none but arterial grafts in patients aged 65 years and older. The cases of 449 consecutive patients who had undergone isolated myocardial revascularization were divided into 2 groups: the arterial conduit group (n=107) received a left internal mammary artery (LIMA) graft and 1 or both radial arteries (RAs), while the mixed-conduit group (n=342) received a LIMA graft and 1 or more saphenous vein grafts (SVGs), with or without an RA. There was no significant difference between the groups' rates of mortality. The arterial conduit group had a significantly shorter overall postoperative hospital stay than did the mixed-conduit group (mean, 6.6 +/- 0.9 vs 7.2 +/- 5 days; P=0.04). Linear regression analysis revealed that the presence of hypertension (beta=0.13; 95% confidence interval [CI], 0.054-0.759; P=0.02) and high EuroSCORE (beta=0.24; 95% CI, 0.053-0.283; P=0.004) were the major predicting factors for long hospital stay. Graft-harvest-site infection was statistically more frequent in the mixed-conduit group than in the arterial conduit group (6.4% vs 0, respectively; P=0.007). Angiography was performed postoperatively (mean, 24.9 +/- 16.3 mo; range, 11-65 mo) in 21 patients. In these patients, all LIMA grafts were patent, as were 86.9% of the SVGs and 90.9% of the RA grafts. Myocardial revascularization using all arterial grafts (at least 50% RAs) in patients aged 65 years and older is safe and reliable, produces short-term results equal to those of saphenous vein grafting, and can reduce graft-harvest-site infections.


Subject(s)
Coronary Artery Bypass/methods , Coronary Artery Disease/surgery , Radial Artery/transplantation , Saphenous Vein/transplantation , Age Factors , Aged , Chi-Square Distribution , Coronary Angiography , Coronary Artery Bypass/adverse effects , Coronary Artery Bypass/mortality , Coronary Artery Disease/diagnostic imaging , Coronary Artery Disease/mortality , Female , Humans , Length of Stay , Linear Models , Male , Radial Artery/diagnostic imaging , Retrospective Studies , Risk Assessment , Risk Factors , Saphenous Vein/diagnostic imaging , Surgical Wound Infection/etiology , Time Factors , Tissue and Organ Harvesting/adverse effects , Treatment Outcome , Turkey , Vascular Patency
17.
J Card Surg ; 23(6): 693-6, 2008.
Article in English | MEDLINE | ID: mdl-19016993

ABSTRACT

BACKGROUND: We evaluated our experience with axillary artery perfusion technique in acute type A aortic dissection repair. METHODS: Between September 2000 and July 2006, 41 consecutive patients with acute type A aortic dissection underwent surgical repair. In 35 of 41 patients (85.4%), arterial perfusion was performed through right axillary artery and in the remaining six patients (14.6%), arterial perfusion site was femoral artery. Indication for femoral artery perfusion was cardiac arrest and ongoing cardiopulmonary resuscitation in one and pulselessness of right upper limb in five patients. Mean age was 54.9 +/- 15.3 (16 to 90 years) and 28 were male. Unilateral antegrade cerebral perfusion (perfusate temperature 22 to 25 degrees C) through axillary artery was performed in all axillary artery perfused patients and in three patients who had femoral artery perfusion. RESULTS: Five patients died postoperatively (hospital mortality 12.2%). All of them had evidence of single or multiple organ malperfusion preoperatively. We did not experience any new transient or permanent neurologic deficit after the procedure in the unilateral antegrade cerebral perfusion patients. Complications related to axillary artery cannulation were observed in two patients (5.3%). One patient with femoral artery cannulation experienced femoral arterial thrombosis, postoperatively. CONCLUSIONS: Right axillary artery cannulation for repair of acute type A aortic dissection is a simple and safe procedure. In the case of pulselessness of right upper limb, femoral artery is still the choice of cannulation site.


Subject(s)
Aortic Aneurysm, Thoracic/surgery , Aortic Dissection/surgery , Catheterization/methods , Femoral Artery , Acute Disease , Adolescent , Adult , Aged , Aged, 80 and over , Cardiopulmonary Resuscitation , Catheterization/adverse effects , Feasibility Studies , Female , Heart Arrest , Humans , Male , Middle Aged , Retrospective Studies , Survival Analysis , Young Adult
19.
Tex Heart Inst J ; 34(2): 154-9, 2007.
Article in English | MEDLINE | ID: mdl-17622360

ABSTRACT

For safe resection, left ventricular aneurysmal repair after acute myocardial infarction is usually delayed. However, delaying surgery may not be possible or prudent in some patients who are clinically unstable after acute myocardial infarction. We retrospectively reviewed the early and mid-term outcomes of left ventricular aneurysmal repair in patients who had experienced acute myocardial infarction <30 days before the repair. From September 2001 through May 2006, 127 consecutive post-infarction patients underwent concurrent anteroapical left ventricular aneurysmal repair and coronary artery bypass grafting. In Group I (38 clinically unstable patients), the surgery was performed <30 days after myocardial infarction. In Group II, 89 patients underwent the surgery > or = 30 days after infarction. The mean follow-up period was 26.16 +/- 16.41 months. One Group I patient (2.6%) died in the hospital due to graft-versus-host reaction. Three Group II patients (3.4%) died: 2 of low cardiac output and 1 of multiple-organ failure. Hospital mortality rates were not statistically significant between groups (P=0.582). All patients required similar perioperative inotropic support, intra-aortic balloon pump support, and re-exploration for bleeding or cardiac tamponade. The actuarial survival rates were 94.7% (Group I) and 94.4% (Group II). Postoperative New York Heart Association functional class improved similarly in both groups. We infer that left ventricular aneurysmal repair with coronary revascularization < 30 days after a recent myocardial infarction is a feasible procedure, with acceptable morbidity and mortality rates. Our mid-term results were comparable with those for patients who underwent this surgery > or = 30 days after acute myocardial infarction.


Subject(s)
Cardiac Surgical Procedures , Heart Aneurysm/surgery , Myocardial Infarction/complications , Aged , Cardiac Surgical Procedures/adverse effects , Coronary Artery Bypass , Feasibility Studies , Female , Follow-Up Studies , Heart Aneurysm/etiology , Heart Aneurysm/mortality , Heart Ventricles/surgery , Humans , Kaplan-Meier Estimate , Male , Middle Aged , Myocardial Infarction/mortality , Retrospective Studies , Severity of Illness Index , Time Factors , Treatment Outcome
20.
Tex Heart Inst J ; 34(2): 240-3, 2007.
Article in English | MEDLINE | ID: mdl-17622379

ABSTRACT

Acute Stanford type A aortic dissection in a patient with severe pectus excavatum constitutes a surgical emergency and presents a major challenge for the surgeon. Decisions must be made regarding the operative approach and whether the pectus excavatum should be corrected during the same session. Herein, we describe a case of acute aortic dissection in a patient who had Marfan syndrome with severe pectus excavatum. Combined partial upper sternotomy and left anterior thoracotomy provided excellent surgical exposure, and the aortic root and ascending aorta were completely replaced. The procedures were successful, and the patient recovered. Technical and surgical considerations led us to postpone concomitant correction of the pectus excavatum.


Subject(s)
Aortic Aneurysm/surgery , Aortic Dissection/surgery , Blood Vessel Prosthesis Implantation , Cardiac Surgical Procedures , Funnel Chest/etiology , Marfan Syndrome/complications , Acute Disease , Adult , Aortic Dissection/diagnostic imaging , Aortic Dissection/etiology , Aortic Aneurysm/diagnostic imaging , Aortic Aneurysm/etiology , Funnel Chest/diagnostic imaging , Humans , Male , Marfan Syndrome/diagnostic imaging , Sternum/abnormalities , Sternum/surgery , Thoracotomy , Tomography, X-Ray Computed , Treatment Outcome
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