ABSTRACT
BACKGROUND: Postoperative bleeding in aortic root aneurysms had represented a challenge. METHODS: Intraoperative testing of the annular or subannular aortic anastomosis, during procedures involving replacement of the aortic root, with either synthetic tube graft, a composite graft or an allograft is described. By reversing the flow of the LV vent and delivering cardioplegia into the left ventricle and thereby pressurizing the left ventricle and its outflow, this technique enables the surgeon to simulate the volume loaded heart, prior to completion of the distal anastomosis. A systematic assessment of the proximal suture line can then be undertaken. Portions of the proximal suture line, particularly the posterior aspect, are obscured if the inspection takes place after completion of both aortic anastomoses, the coronary attachments, as well as from the presence of the main pulmonary artery and by the distended aorta itself. RESULTS: The use of this method in 34 patients is described without untoward events related to this technique. CONCLUSIONS: The advantages of this technique are a rapid and safe assessment of the integrity of the proximal suture line bed.
Subject(s)
Aortic Aneurysm, Thoracic/surgery , Postoperative Hemorrhage/prevention & control , Adolescent , Adult , Aged , Anastomosis, Surgical/adverse effects , Aortic Valve Insufficiency/surgery , Cardiac Surgical Procedures , Female , Humans , Male , Middle AgedABSTRACT
A possible new functional mechanism of atheromatous embolus is presented resulting from reversed aortic blood flow during diastolic augmentation by balloon counterpulsation. This mechanism is different from mechanical disruption during insertion. Despite this, intra-aortic balloon remains an important asset in the management of hemodynamically challenged patients.
Subject(s)
Aortic Diseases/etiology , Embolism, Cholesterol/etiology , Intra-Aortic Balloon Pumping/adverse effects , Aorta, Thoracic , Aortic Diseases/diagnostic imaging , Cardiac Catheterization , Coronary Artery Bypass , Embolism, Cholesterol/diagnostic imaging , Humans , Male , Middle Aged , Myocardial Infarction/therapy , UltrasonographyABSTRACT
OBJECTIVES: We examined whether bilateral internal thoracic artery (BITA) revascularization is associated with any increased in-hospital mortality and complications compared with single internal thoracic artery (SITA) revascularization. BACKGROUND: Despite proven long-term benefits, BITA revascularization has been slow to be adopted because of fear of increased early morbidity. METHODS: We evaluated 1,697 consecutive patients undergoing BITA (n = 867) or SITA (n = 830) revascularization. We used propensity score analyses and adjusted risk models to address differences between arms. RESULTS: There were 20 (2.3%) deaths in the BITA group versus 26 (3.1%) in the SITA group (odds ratio 0.73, p = 0.30). Propensity analysis identified several parameters that affected the decision to use BITA. Adjusting for propensity score and all potential risk factors, the odds ratio for death with BITA versus SITA was practically 1. Bilateral internal thoracic artery revascularization did not increase the number of in-hospital complications with the possible exception of deep sternal wound infections (11 [1.3%] vs. 3 [0.4%], p = 0.057). In multivariate modeling BITA increased the risk of deep sternal wound infections only in emergent cases and in older patients; the excess risk was negligible among 1,206 patients (71.1% of total) who did not have emergent revascularization and were < or =70 years old (risk difference 0.3%, p = 0.74). There was no difference in length of stay after adjustment for propensity factors (mean 11.3 vs. 11.7 days, p = 0.66). CONCLUSIONS: Bilateral internal thoracic artery revascularization grafting confers no increased risk for early death and does not prolong hospital stay. The small increase in the risk of deep sternal wound infections does not affect the majority of patients.
