ABSTRACT
AIM: to assess effect of correction of moderate ischemic mitral regurgitation (IMR) in patients with ischemic cardiomyopathy (IMC) in immediate and remote period. MATERIALS AND METHODS: We included in a single center prospective study 76 patients with IMC, left ventricular ejection fraction ≤35 %, and moderate IMR. Patients with indications to postinfarction aneurism repair were not included. For randomization we used the method of envelopes. Thirty-eight patients were randomized in the group where coronary artery bypass grafting (CABG) was combined with of mitral valve repair (MVR), and 38 patients in the control group of isolated CABG. Mean age of patients was 57±8 (from 30 to 75 леÑ) years. For IMR correction we used rigid MEDENG ring. Results. Inhospital mortality was 5.4 % (n=2) after isolated CABG and 10.81 % (n=4) after CABG + MVR. Main cause of death was acute heart failure. One- and 2year survival was 84 and 78 %, respectively, after CABG+MVR, and 84 and 71 % after isolated CABG. There was significant difference in three-year survival between groups (hazard ratio [HR] of death 0.457, p=0.04). Five-year survival was 45 and 74 % after isolated CABG and CABG+MVR, respectively (Ñ=0.037). Factors associated with inhospital mortality were pulmonary hypertension (HR 2.177, 95 % confidence interval [CI] 2.299 to 9.831; p=0.043), NYHA class IV chronic heart failure (HR 3.027, 95 % CI 1.605 to 5.707; Ñ=0.001), negative result of stress test echocardiography (HR 0.087, 95 %CI 0.041 to 0.186; Ñ<0.001), atrial fibrillation (HR 4.754, 95 %CI 2.299 to 9.831; Ñ<0.001). CONCLUSION: Correction of moderate IMR in patients with IMC leads to improvement of parameters of survival in remote period. Five-year survival after isolated CABG was 45 %, while after CABG+MVR - 74 % (Ñ=0.037).
Subject(s)
Mitral Valve Insufficiency , Myocardial Ischemia , Adult , Aged , Coronary Artery Bypass , Humans , Middle Aged , Prospective Studies , Treatment Outcome , Ventricular Function, LeftABSTRACT
AIM: To estimate the results of sternomediastinitis management using vacuum-therapy compared with conventional treatment of such wounds. MATERIAL AND METHODS: We have retrospectively analyzed data for the period from January 2007 to October 2014. The study enrolled 79 patients with infectious complication after cardiac surgery. All patients underwent coronary artery bypass grafting. The first group included 40 patients who received conventional therapy. The second group enrolled 39 patients in whom vacuum-therapy was applied. Patients were comparable in main characteristics. RESULTS: Mortality rate was significantly lower in vacuum-therapy group (2.5% vs. 15%, p=0.05). Similarly duration of hospital-stay in the 2nd group was 29±10 days, in the 1st group - 47±11 days (p<0.01). Incidence of sepsis and other complications was significantly higher in group of conventional treatment. CONCLUSION: Vacuum-therapy for infectious complications after cardiac surgery provided good results including decrease of hospital-stay duration and mortality rate in comparison with conventional management of wounds.
Subject(s)
Coronary Artery Bypass/adverse effects , Mediastinitis/therapy , Negative-Pressure Wound Therapy/methods , Osteitis/therapy , Surgical Wound Infection/therapy , Female , Follow-Up Studies , Hospital Mortality/trends , Humans , Incidence , Male , Mediastinitis/epidemiology , Mediastinitis/etiology , Middle Aged , Osteitis/epidemiology , Osteitis/etiology , Retrospective Studies , Siberia/epidemiology , Sternum , Surgical Wound Infection/epidemiology , Surgical Wound Infection/etiology , Treatment OutcomeABSTRACT
Described in the article is a clinical case report concerning surgical treatment of a 65-year-old male patient presenting with a ruptured infectious aortic arch aneurysm. He was subjected to an operation consisting in prosthetic repair of the ascending portion of the aorta and aortic arch with a homograft under conditions of artificial circulation, deep hypothermia, and antegrade cerebral perfusion.
Subject(s)
Aneurysm, Infected , Aortic Aneurysm, Thoracic , Aortic Rupture/surgery , Aortography/methods , Clostridium tertium/isolation & purification , Vascular Grafting , Aged , Aneurysm, Infected/diagnosis , Aneurysm, Infected/microbiology , Aneurysm, Infected/physiopathology , Aneurysm, Infected/surgery , Aorta, Thoracic/diagnostic imaging , Aorta, Thoracic/surgery , Aortic Aneurysm, Thoracic/diagnosis , Aortic Aneurysm, Thoracic/microbiology , Aortic Aneurysm, Thoracic/physiopathology , Aortic Aneurysm, Thoracic/surgery , Aortic Rupture/diagnosis , Aortic Rupture/physiopathology , Blood Vessel Prosthesis , Echocardiography/methods , Extracorporeal Circulation/methods , Humans , Hypothermia, Induced/methods , Male , Pericardial Effusion , Tomography, X-Ray Computed/methods , Treatment Outcome , Vascular Grafting/instrumentation , Vascular Grafting/methodsABSTRACT
Presented herein is a case report of successful surgical management of a 34-year-old female patient diagnosed with carotid chemodectoma, a relatively rare pathology vascular surgeons come across and have to deal with. A comprehensive examination (including duplex scanning of cervical arteries, multispiral CT angiography) revealed a 7 x 8 cm cervical tumour completely invading the walls of both the external and internal carotid arteries, thus requiring their resection, followed by prosthetic replacement of the internal carotid artery with a synthetic graft. The postoperative period turned out uneventful. On the 7th postoperative day, the patient was discharged home from hospital in a satisfactory condition with good laboratory and haemodynamic values.
