ABSTRACT
OBJECTIVE: The aim of this study was to evaluate the midterm results of the reimplantation technique with a straight tubular graft in patients with aortic root aneurysms with or without aortic insufficiency. METHODS: From February 2002 to November 2012, 51 consecutive patients underwent the David I valve-sparing aortic procedure for aortic root aneurysm; the mean age was 59.9±12.3 years. Nine patients (17.6%) had a bicuspid aortic valve. Patients were followed prospectively for 4.78±3.60 years (median, 5 years). Operative results, survival, freedom from redo aortic surgery and from recurrent aortic insufficiency greater than 2+ were assessed. RESULTS: No in-hospital mortality was recorded. In 5 cases, adjunctive procedures on the aortic valve were needed to achieve good leaflet coaptation. Aortic regurgitation was significantly lower at discharge (2.3±1.0 vs 0.3±0.5; P<.001). There were 5 postoperative deaths, all noncardiac related. Survival was 91.0%±4.4% at 5 years; freedom from redo aortic surgery was 96.8%±3.2% and freedom from recurrent aortic insufficiency greater than 2+ was 96.8%±3.2%. The outcomes in patients with repaired bicuspid aortic valves showed no significant differences compared to the outcomes in patients with repaired tricuspid valves. CONCLUSIONS: The reimplantation procedure using a straight tube is a safe and reproducible valve-sparing technique that can achieve no in-hospital mortality and durable midterm results, either in bicuspid or tricuspid valves. Further studies are needed to assess the behavior of repaired valves under physical stress at long-term follow-up.
Subject(s)
Aortic Aneurysm, Thoracic/surgery , Aortic Valve Insufficiency/surgery , Aortic Valve/abnormalities , Heart Valve Prosthesis Implantation/methods , Heart Valve Prosthesis , Adult , Aged , Aortic Aneurysm, Thoracic/diagnostic imaging , Aortic Valve Insufficiency/diagnostic imaging , Coronary Angiography , Echocardiography, Transesophageal , Female , Humans , Male , Middle Aged , Replantation/methods , Retrospective Studies , Treatment OutcomeABSTRACT
We here report a very unusual presentation of ruptured thoracic aortic aneurysm. In a 50-year-old patient, almost asymptomatic and in stable clinical conditions, the chest radiograph and computed tomography scan revealed a right-sided rupture of a previously undiagnosed thoracic aortic aneurysm. The patient was treated successfully with an emergency surgical procedure.
Subject(s)
Abdominal Pain/etiology , Aortic Aneurysm, Thoracic/diagnosis , Aortic Rupture/diagnosis , Hemothorax/etiology , Abdominal Pain/diagnostic imaging , Aortic Aneurysm, Thoracic/complications , Aortic Aneurysm, Thoracic/diagnostic imaging , Aortic Aneurysm, Thoracic/surgery , Aortic Rupture/complications , Aortic Rupture/diagnostic imaging , Aortic Rupture/etiology , Aortic Rupture/surgery , Hemothorax/diagnostic imaging , Humans , Male , Middle Aged , Rupture, Spontaneous , Tomography, X-Ray Computed , Treatment Outcome , Vascular Surgical ProceduresABSTRACT
Re-fixation of the sternum after sternal dehiscence is still a problem following cardiac surgery. An original technique that allows reinforcement against various causes of dehiscence is described. The technique consists of 3 additional overlapping longitudinal wires set on both sides of the sternum. Over 2 years, this technique was applied in 34 patients, with complete sternal re-fixation in all, and no signs of recurrence on follow-up.
Subject(s)
Fracture Fixation, Internal/methods , Sternum/surgery , Surgical Wound Dehiscence/surgery , Thoracotomy/adverse effects , Bone Wires , Humans , Surgical Wound Dehiscence/etiologyABSTRACT
OBJECTIVE: We designed this study to evaluate the early hemodynamic performance of the recently introduced Carpentier-Edwards PERIMOUNT Magna bioprosthesis (Edwards Lifesciences, Irvine, Calif) and compare it with those of the conventional Carpentier-Edwards PERIMOUNT stented bioprosthesis (Edwards Lifesciences) and Edwards Prima Plus porcine stentless bioprosthesis (Edwards Lifesciences). METHODS: Sixty-three patients (>70 years old) were enrolled in this prospective, randomized study. At operation, once the annulus had been measured, the best size suitable was assessed for each of the three valves before random assignment. Transthoracic echocardiography was performed before discharge to evaluate early postoperative hemodynamic performances of the different valves implanted. RESULTS: The best size suitable of Edwards Prima Plus (24.3 +/- 1.7 mm) was significantly superior to those of both the Carpentier-Edwards PERIMOUNT Magna (23.4 +/- 2.1 mm) and Carpentier-Edwards PERIMOUNT (22.4 +/- 1.8 mm). The best size suitable of the Carpentier-Edwards PERIMOUNT Magna, however, was significantly superior to that of the Carpentier-Edwards PERIMOUNT. Furthermore the best size suitable of the Carpentier-Edwards PERIMOUNT Magna was equal to the measured annulus in 55% of patients, as opposed to 25% for the Carpentier-Edwards PERIMOUNT (P < .001). Mean implanted labeled size of the Edwards Prima Plus was significantly higher than those of both the Carpentier-Edwards PERIMOUNT Magna and the Carpentier-Edwards PERIMOUNT (24.6 +/- 1.9 mm, 23.1 +/- 1.9 mm, and 22.5 +/- 1.8 mm, respectively). Early postoperative hemodynamic performance of the Carpentier-Edwards PERIMOUNT Magna, however, was superior to those of both the Edwards Prima Plus and the Carpentier-Edwards PERIMOUNT in both effective orifice area index (1.07 +/- 0.4 cm2/m2, 0.87 +/- 0.3 cm2/m2, and 0.80 +/- 0.2 cm2/m2, respectively) and mean peak gradient (20 +/- 6 mm Hg, 27 +/- 8 mm Hg, and 28 +/- 12 mm Hg, respectively). CONCLUSION: The improved design of the recently introduced third-generation stented bioprosthesis Carpentier-Edwards PERIMOUNT Magna allows implantation of a significantly bigger valve than with the old generation. Furthermore, the improved hemodynamic performance of the Carpentier-Edwards PERIMOUNT Magna compares favorably with both the Carpentier-Edwards PERIMOUNT and the Edwards Prima Plus.
