Comparative analysis of the results of cyanoacrylate ablation and radiofrequency ablation in the treatment of venous insufficiency.

BACKGROUND: Varicose vein treatment has shifted to less invasive techniques owing to the complications associated with traditional treatment. The present study was designed to compare the effectiveness of cyanoacrylate ablation (CAA) with radiofrequency ablation (RFA). METHODS: Patients who had undergone RFA vs CAA (634 vs 246 patients) to treat great saphenous vein (GSV) insufficiency during a 5-year period were included in the present study. The preoperative and postoperative CEAP (clinical, etiologic, anatomic, pathophysiologic) class, symptoms, recurrence, and Doppler ultrasound findings were compared. RESULTS: All the veins in both groups were occluded at day 5. The 1-month closure rates were 97.3% and 98.7% for RFA and CAA, respectively. The overall postoperative closure rates at 5 years were 93.1% and 91.1% for RFA and CAA, respectively. The postoperative symptoms, CEAP class, and Doppler ultrasound findings were similar in both groups. The 5-year symptom-free survival rates were 73.5% and 72.0% in the RFA and CAA groups, respectively. The venous clinical severity scores had decreased from 5.9 ± 1.2 to 0.9 ± 0.8 and 5.8 ± 0.9 to 0.8 ± 0.6 in the RFA and CAA groups, respectively. The Aberdeen varicose vein questionnaire scores had decreased from 19.7 ± 5.5 to 4.8 ± 1.5 in the RFA group and from 18.9 ± 5.8 to 4.9 ± 1.4 in the CAA group. CONCLUSIONS: CAA seems to be the ideal treatment for GSV insufficiency because it is suitable for most patients and is nonthermal and nontumescent, with satisfactory results comparable to those with RFA. Long-term outcomes and cost analyses from larger series are required to confirm our findings.

Renal failure after coronary bypass surgery and the associated risk factors.

OBJECTIVE: We aimed to evaluate the risk factors associated with acute renal failure in patients who underwent coronary artery bypass surgery. METHODS: One hundred and six patients who developed renal failure after coronary artery bypass grafting (CABG) constituted the study group (RF group), while 110 patients who did not develop renal failure served as a control group (C group). In addition, the RF group was divided into two subgroups: patients that were treated with conservative methods without the need for hemodialysis (NH group) and patients that required hemodialysis (HR group). Risk factors associated with renal failure were investigated. RESULTS: Among the 106 patients that developed renal failure (RF), 80 patients were treated with conservative methods without any need for hemodialysis (NH group); while 26 patients required hemodialysis in the postoperative period (HR group). The multivariate analysis showed that diabetes mellitus and the postoperative use of positive inotropes and adrenaline were significant risk factors associated with development of renal failure. In addition, carotid stenosis and postoperative use of adrenaline were found to be significant risk factors associated with hemodialysis-dependent renal failure (P < .05). The mortality in the RF group was determined as 13.2%, while the mortality rate in patients who did not require hemodialysis and those who required hemodialysis was 6.2% and 34%, respectively. CONCLUSIONS: Renal failure requiring hemodialysis after CABG often results in high morbidity and mortality. Factors affecting microcirculation and atherosclerosis, like diabetes mellitus, carotid artery stenosis, and postoperative vasopressor use remain the major risk factors for the development of renal failure.

An alternative treatment for varicose veins: ligation plus foam sclerotherapy.

BACKGROUND: Varicose vein treatment has been directed toward less-invasive yet lasting techniques. OBJECTIVE: To compare the effectiveness of an alternative treatment (ligation plus foam sclerotherapy) with that of a classic stripping technique. MATERIALS AND METHODS: The study included 216 and 156 patients who had undergone classic stripping and foam sclerotherapy, respectively, within the previous 5 years. Preoperative and postoperative CEAP class, symptoms, recurrence, and Doppler findings of the two groups were compared. RESULTS: There were no differences between treatments in terms of postoperative symptoms, Doppler findings, or CEAP class. The predictors of postoperative CEAP class were bilateral limb disease and prior deep vein thrombosis (DVT), whereas the predictors of symptom recurrence were bilateral limb disease, preoperative CEAP class, occupation, and familial or genetic predisposition. The predictors of postoperative perforator incompetence (PI) were occupation, aged 60 and older, preoperative CEAP class, and preoperative PI, whereas the only predictor of postoperative deep vein incompetence (DVI) was preoperative DVI. Five-year symptom-free survival rates were 51 ± 0.8% in the foam sclerotherapy group and 46 ± 0.9% in the stripping group. CONCLUSION: The safety and efficacy of ligation plus foam sclerotherapy as an alternative technique allowing for same-day surgery to treat varicose veins are the same as those of classic stripping. The predictors of postoperative outcome depend on individual patient characteristics.

Malperfusion remains the major cause of mortality in proximal aortic operations.

BACKGROUND: This study was undertaken to identify the incremental risk factors for early mortality in operations for proximal aortic pathologies. METHODS: Between September 2000 and May 2010, 240 consecutive patients underwent replacement of various portions of the proximal aorta. Mean age was 56 ± 13 years (range 18 to 84) and female/male ratio was 3/7. Operations were performed emergently in 97, urgently in 21, and electively in 122 patients. Thirty-four patients had previous cardiac or aortic operations. Etiology was acute dissection in 102, chronic dissection in 41, degenerative aneurysm in 61, and other factors (endocarditis, pseudoaneurysm, aortitis, etc.) in 36 patients. The ascending aorta was replaced in all patients. In addition, the aortic arch was replaced in 20 and the root was replaced in 106 patients. RESULTS: The in-hospital mortality rate was 10.4% in the overall group (25/240), 21.6% in emergent cases (21/97), 9.5% in urgent cases (2/21), and 1.6% in elective cases (2/122). Morbidity rates were as follows: stroke 2.7%, temporary neurological dysfunction 13.3%, nonoliguric renal failure 3%, dialysis 5.4%, tracheostomy 3.3%, bleeding requiring revision 3.3%. In multivariate analysis, the presence of malperfusion in patients with acute aortic dissection emerged as the incremental risk factor for mortality (p < 0.0001, odds ratio = 10.37). There was no variable associated with stroke. Emergency/urgency of operation did not emerge as incremental risk factors for mortality. CONCLUSION: Immediate outcomes of elective aortic operations for proximal aortic pathologies are excellent. Complicated acute dissections with malperfusion remain the major cause of early mortality.

Immediate clinical outcome after prolonged periods of brain protection: retrospective comparison of hypothermic circulatory arrest, retrograde, and antegrade perfusion.

BACKGROUND AND AIM: We aimed to compare the immediate clinical outcome after different cerebral perfusion methods, and examine the factors affecting the mortality and neurological outcome. METHODS: Between 1993 and 2006, 339 patients underwent proximal aortic operations using a period of cerebral protection. Among these, 161 patients (mean age of 55 +/- 12 years) who required cerebral protection longer than 25 minutes were included in the analysis. Ascending aorta with or without root was replaced in all patients. In addition, total arch replacement was performed in 36 patients. All patients were cooled to rectal temperature of 16 degrees C. Hypothermic circulatory arrest without adjunctive perfusion was used in 48 patients. Retrograde or antegrade cerebral perfusion was added in 94 and 19 patients, respectively. The mean duration of total cerebral protection was 42 +/- 17 minutes. RESULTS: Overall mortality was 15.5% (25/161) and did not differ among the perfusion groups. There was no difference in the incidence of overall neurological events, temporary neurological dysfunction, or major stroke among the groups. Multivariate analysis revealed that transfusion of >3 units of blood (p < 0.03) was an incremental risk factor for mortality. History of hypertension (p < 0.03), coexisting systemic diseases (p < 0.005), and transfusion of >3 units of blood (p < 0.04) were predictors of temporary neurological dysfunction. CONCLUSION: In proximal aortic operations requiring prolonged periods of cerebral protection, the mortality and neurological morbidity are not determined by the type of cerebral protection method only. Factors like hypertension and diabetes may play a role in the development of temporary neurological dysfunction.

Rupture of a nonaneurysmal abdominal aorta due to spondylitis.

Contiguous arterial infections are extremely rare, and their actual rate of occurrence is not known. These infections occur as a result of direct invasion of an artery from an adjacent septic focus. Reaching the diagnosis of infected aorta is very difficult when there are contiguous infections from spondylitis or psoas abscess, because the clinical features are nonspecific. Although computed tomography is the most useful diagnostic tool in the detection of aortic infections, the most frequent findings mimic those of other diseases, such as retroperitoneal fibrosis, lymphoma, and periaortic lymphadenopathy. Diagnosis becomes even more challenging when an infected aorta is of normal diameter. Herein, we report the case of a 64-year-old man who experienced nonaneurysmal abdominal aortic rupture due to spondylitis and psoas abscess. Despite appropriate surgical management, the patient later died. We review the relevant medical literature and examine specific considerations that surround the diagnosis and treatment of this rare condition.

Diagnostic accuracy of N-terminal pro-brain natriuretic peptide in the evaluation of postoperative left ventricular diastolic dysfunction.

We compared the diagnostic accuracy of N-terminal prohormone brain natriuretic peptide (NT-proBNP) with that of echocardiography in the evaluation of left ventricular diastolic dysfunction after coronary artery bypass grafting. Thirty patients were studied prospectively. Patients who had recent myocardial infarction, unstable angina pectoris, or low ejection fraction with systolic dysfunction were excluded. Two blood samples were obtained: before anesthetic induction and on the 7th postoperative day. Levels of NT-proBNP were measured by electrochemiluminescence immunoassay. Comprehensive echocardiographic Doppler examinations were performed on admission and on the 7th postoperative day. Relationships between NT-proBNP levels and echocardiographic indices were evaluated by correlation, multiple linear regression, and receiver-operating characteristic curve analysis. There were significant and correlated worsenings in diastolic stage as determined both by echocardiographic indices and NT-proBNP levels. Early transmitral-to-early diastolic annular velocity ratio (E/Ea) was found to correlate with both NT-proBNP and postoperative diastolic functional stage (r=0.78, P <0.001). Mitral E/Ea was significantly more sensitive than were NT-proBNP levels in predicting diastolic functional stage. The area under the receiver-operating characteristic curve for NT-proBNP was significantly lower than that of mitral E/Ea (mean difference, 0.12; P=0.024). The NT-proBNP had 87.5% sensitivity and 55% specificity, whereas E/Ea had 87.5% sensitivity and 86.4% specificity. Plasma NT-proBNP levels are significantly related to mitral E/Ea ratio, which is a predictor of diastolic stage. Therefore, elevated NT-proBNP levels may indicate the time for a Doppler echocardiographic evaluation and identify a subgroup of patients at high risk who need closer monitoring during the early postoperative period.

A study on 4-acylamino-4,5-dihydro-1H-1,2,4-triazol-5-ones.

Five novel 3-alkyl-4-phenylacetylamino-4,5-dihydro-1H-1,2,4-triazol-5-ones (2) were synthesized by the reactions of 3-alkyl-4-amino-4,5-dihydro-1H-1,2,4-triazol-5-ones (1) with phenylacetyl chloride and characterized by elemental analyses and IR, 1HNMR, 13C-NMR and UV spectral data. The newly synthesized compounds 2 were titrated potentiometrically with tetrabutylammonium hydroxide in four non-aqueous solvents such as isopropyl alcohol, tert-butyl alcohol, acetonitrile and N,N-dimethylformamide, and the half-neutralization potential values and the corresponding pKa values were determined for all cases. In addition, these new compounds and five recently reported 3-alkyl-4-(pmethoxybenzoylamino)-4,5-dihydro-1H-1,2,4-triazol-5-ones (3) were screened for their antioxidant activities.

Clinical outcomes in "complex" thoracic aortic surgery.

Although the term "complex aortic surgery" has come into increasing use, it has not been defined. We propose the following definition: replacement or remodeling (not resuspension of commissures) of the aortic root, together with either an intracardiac procedure or a replacement of more than 1 segment of aorta, all of which require cerebral protection. We retrospectively analyzed data pertaining to 152 patients (mean age, 56 +/- 12 years) who underwent surgery for thoracic aortic disease with aid of cardiopulmonary bypass from October 2000 through December 2005. The replaced segment was the ascending aorta with or without the root in 106 patients, the aortic arch in 15, and the descending aorta in 31. Among these patients, 10 met our proposed criteria and constituted the complex group. In this group, in addition to the aortic root, the entire thoracic aorta (ascending, arch, and descending) was replaced in 4 patients, the total arch in 2, and a partial arch in 1. The remaining 3 underwent valve or coarctation repair. Their outcomes were analyzed as a sub-group within the overall outcome. The in-hospital mortality rate was 12.5% in the overall group (19/152), 4.1% in elective cases (3/73), and 10% in the complex group (1/10). Duration of cardiopulmonary bypass, myocardial ischemia, and total cerebral protection times were significantly longer in the complex group (P <0.0001). Total cerebral protection time over 40 minutes was the only predictor of neurologic morbidity (P = 0.003; odds ratio, 4.7). Procedural complexity, as we defined it, increased neurologic morbidity, but not the mortality rate.

Effects of thoracic and hiatal clamping in repair of ruptured abdominal aortic aneurysms.

The purpose of this study was to determine the effects of hiatal and thoracic clamping on postoperative outcome and morbidity and factors affecting mortality and morbidity. The records of 102 patients who had undergone ruptured abdominal aortic aneurysm repair between 1993 and 2005 were evaluated retrospectively. Hiatal clamping and thoracic clamping were performed in 72 patients and 30 patients, respectively. Postoperative complications and survival were evaluated comparatively between the two groups by univariate and multivariate statistical analyses. Overall mortality and hospital mortality rates were 63 (61.8%) and 24 (23.5%) patients, respectively; and there was no difference between the two groups. Postoperative respiratory complications, gastrointestinal complications, and blood requirement were higher in the thoracic clamping group. Preoperative shock and renal ischemia time (>30 min) were found to be significant predictors of hospital mortality. Postoperative renal failure was the only independent postoperative predictor of mortality. In the follow-up period, cardiac event was an independent predictor of late mortality. If hospital mortalities were excluded, 5-year and 10-year cumulative survivals were 57.82 +/- 5.85% and 38.16 +/- 6.97%, respectively. Cross-clamp level did not have a significant effect on long-term survival. Although both thoracic and hiatal clamping had no effect on mortality, postoperative respiratory complications, blood requirement, and intestinal ischemia were more pronounced in patients operated with thoracic clamping. Hiatal clamping is preferable for a safe postoperative period.

Effects of pleurotomy on respiratory sequelae after internal mammary artery harvesting.

The preservation of pleural integrity during mammary artery harvesting may decrease atelectasis and pleural effusion during the postoperative period. We designed this retrospective study to evaluate the effects on postoperative pulmonary function of pleural integrity versus opened pleura, in patients who receive a left internal mammary artery graft. The study group consisted of 1141 patients who underwent elective coronary artery bypass grafting. The patients were retrospectively evaluated and divided into 2 groups: those who underwent internal mammary artery harvesting with opened pleura (n=873) or with pleural integrity (n=268). To monitor pleural effusion and atelectasis, chest radiography was performed routinely 1 day before operation and on the 2nd, 5th, and 7th postoperative days. The preoperative, after extubation, and 1st postoperative day values of partial oxygen pressure (PaO2), partial carbon dioxide pressure (PaCO2), and oxygen (O2) saturation were recorded for comparison, as was the hematocrit. The mean age of the patients was 574 +/- 8.81 years. There were no significant differences between the groups in mean values of PaO2, PaCO2, O2 saturation, and hematocrit after extubation or on the 1st postoperative day. Atelectasis on the 5th and 7th postoperative days, pleural effusion on the 2nd, 5th, and 7th days, and postoperative bleeding were significantly less in the group with preserved pleural integrity. We showed that preservation of pleural integrity during internal mammary artery harvesting decreases postoperative bleeding, pleural effusion, and atelectasis. We conclude that preservation of pleural integrity, when possible, can decrease these postoperative complications of coronary artery bypass grafting.

Detachment of the mitral valve anterior leaflet as a complication of aortic valve replacement.

Mitral regurgitation after aortic valve replacement is generally reported as a complication of a Manouguian's procedure for annulus enlargement. However, even if no annular enlargement procedure is performed, this complication may be encountered after isolated aortic valve replacement because of either extensive decalcification of the aortic annulus or progressive tension on the anterior leaflet of the mitral valve, caused by aortic valve sutures placed adjacent to firm or heavily calcified valve tissue. Routine transthoracic echocardiography may be inadequate for diagnosis of this condition; transesophageal echocardiography should be used both for preoperative diagnosis and for intraoperative management. We report the case of a patient who had severe mitral regurgitation that occurred after aortic valve replacement with a mechanical valve.

Composite graft endocarditis: repair with a mechanical prosthesis.

We report the case of a 64-year-old man who developed a mediastinal pseudoaneurysm due to severe endocarditis, 2 years after aortic root replacement with a prosthetic composite graft containing a mechanical valve. After a short period of stabilization and antibiotic therapy, the patient underwent surgery. The coronary buttons and the sewing ring of the composite graft were found to be detached from the graft and the annulus, respectively. Re-replacement with a prosthetic composite graft (Dacron graft with a mechanical valve) by the Cabrol procedure was performed. Although the homograft is considered by many surgeons to be the best graft for aortic root replacement, the synthetic composite graft can also be used to treat composite graft endocarditis successfully. The technical aspects of homograft versus synthetic aortic root replacement in patients with endocarditis are discussed briefly.

Perioperative determinants of mortality and morbidity in distal arch and proximal descending aortic aneurysm surgery.

BACKGROUND: The purpose of this article is to describe our experience on distal arch and proximal descending aortic aneurysm repair, and to evaluate retrospectively the determinants of mortality and morbidity. MATERIAL/METHODS: Between 1994 and 2002, 30 patients (mean age 53.4 years) underwent repair of distal arch or proximal descending aortic aneurysm approached through left thoracotomy with deep hypothermic circulatory arrest. Femoro-femoral bypass was used in all patients except for four, in whom the left subclavian artery was cannulated. Retrograde cerebral perfusion was performed in 16 patients. The mean circulatory arrest time was 30.7 min. RESULTS: Overall hospital mortality was 13.3%. Excessive blood (p=0.008) and plasma (p=0.009) transfusions, and coronary artery disease (p=0.012) were correlated with mortality. The overall rate of postoperative complications was 30%. Renal failure and respiratory failure were the most frequent complications (16.7%), while the rates of stroke and transient neurological dysfunction were 6.7% and 3.3%, respectively. Age >70 years, bypass time >140 min, distal ischemia time >55 min, and excessive blood or plasma transfusions were determinants of postoperative complications. CONCLUSIONS: Deep hypothermic circulatory arrest with left thoracotomy is a valid procedure with acceptable mortality rates in the management of aneurysms of distal arch and proximal descending aorta. Prolonged bypass and distal ischemia times and excessive blood transfusions are associated with increased postoperative morbidity.

Predictors of outcome in patients with prosthetic valve dysfunction.

BACKGROUND AND AIM OF THE STUDY: The study aim, based on the authors' experience in patients with prosthetic valve dysfunction, was to investigate risk factors for mortality and morbidity by analyzing preoperative, intraoperative and postoperative variables with respect to early and long-term survival. METHODS: A retrospective analysis was carried out of 132 patients (47 men, 85 women; mean age 46.8 +/- 12.4 years) who presented for treatment of prosthetic valve dysfunction between December 1992 and February 2003. Two patients received thrombolytic therapy and were excluded from the statistical analysis, which comprised only operatively treated patients; four patients underwent successful surgical repair of mitral mechanical prostheses; all other patients (except two who died perioperatively) underwent prosthetic valve re-replacement (n = 124). RESULTS: Overall mortality and hospital mortality rates were 15.2% and 10.6%, respectively. Postoperatively, 54 complications were seen in 42 patients (32.3%). Preoperative left ventricular end-systolic diameter (LVESD) > or = 45 mm and cardiopulmonary bypass (CPB) time > 140 min were independent risk factors for overall and in-hospital mortality. Female gender, age > 60 years and prolonged CPB time were predictors of postoperative complications. The actuarial survival rate was 87.5 +/- 0.3% at five years, and 81.7 +/- 0.4% at 10 years. A reduced left ventricular ejection fraction (LVEF) was the only independent predictor of late death and long-term survival. CONCLUSION: Preoperative LVESD > or = 45 mm and lower LVEF were found to be independent predictors of postoperative mortality and late survival, respectively. It is possible to obtain a substantial improvement in outcome and long-term survival if a valvular reoperation can be performed with shorter CPB time and before left ventricular dysfunction has developed.

Intermittent infusion of 0.25% bupivacaine through an intrapleural catheter for post-thoracotomy pain relief.

BACKGROUND: The present study was designed to evaluate the effectiveness of intrapleural 0.25% bupivacaine delivered by intermittent infusions for post-thoracotomy pain relief. METHODS: Forty patients undergoing elective lobectomy were randomly, but equally, placed into two groups. An intrapleural catheter was inserted under direct vision during surgery. Group I received intrapleural 40 mL of 0.25% bupivacaine, group II was administered 40 mL of saline solution as a control group. Diclofenac sodium was administered as an additional analgesic, if required. Postoperative pain was evaluated using a visual analog scale (VAS), and Prince Henry pain scale. Arterial oxygen saturation, heart rate, and systemic arterial pressures were monitored. All observations were recorded 5, 10, 15, 20, 25, and 30 minutes after the injection, and thereafter at hourly intervals through the postoperative 24 hours. RESULTS: The mean analgesia times were 5 hours and 2 hours in group I and group II, respectively. Therefore, bupivacaine administrations were repeated every 6 hours in group I, and saline with additional analgesic were administered every 4 hours in group II. The heart rate and arterial pressures did not show a significant difference. While the additional analgesic requirement was 180 +/- 10 mg/d in group II, there was no need for additional analgesic administration in the group I patients. Arterial oxygen was significantly higher in group I than in group II. Arterial carbon dioxide tension of group II was significantly higher than that of group I. While the postoperative atelectasis and pneumonia developed in four patients and one, respectively, in group II, no such complication was observed in group I. CONCLUSIONS: The easy placement of an intrapleural catheter and better pain relief observed in the present study suggest that intermittent pleural infusion of 0.25% bupivacaine has proven to be a safe and effective method for relief of post-thoracotomy pain.

Predictors of outcome after coronary artery bypass grafting in patients older than 75 years of age.

BACKGROUND: This study was designed to identify risk factors affecting mortality and morbidity in patients older than 75 years who underwent coronary artery bypass grafting (CABG) with cardiopulmonary bypass. MATERIAL/METHODS: The preoperative, perioperative, and postoperative data of 116 patients older than 75 years who underwent isolated CABG from January 1997 through April 2002 were evaluated retrospectively. Preoperatively, 82 patients (70.7%) were in CCS class III-IV and 65 (56%) were in NYHA class III-IV. Besides mortality, morbidity and survival rates, the statistical significance of predictors of outcome were investigated. RESULTS: Overall mortality and hospital mortality rates were 12.9% (15 patients) and 4.3%, (5 patients), respectively. Postoperative complications were observed in 56 patients (48.3%). In 25.1+/-17.6 months of follow-up, 96 (86.5%) and 101 (91%) of the surviving 111 patients (95.7%) were in NYHA class I and CCS class I, respectively. Prolonged cross-clamp time (>50 min) (p=0.018), COPD (p=0.028), and emergency operation (p=0.001) were found to be the determinants of postoperative complications. The cumulative 5-year survival rate was 77.2 +/-0.8%. CONCLUSIONS: Elective CABG in older patients with shorter bypass and cross-clamp times, after the management of comorbid disease, such as COPD, is a safe procedure with low mortality and morbidity rates, showing postoperative improvements in functional capacity and angina class.

Amiodarone reduces the incidence of atrial fibrillation after coronary artery bypass grafting.

OBJECTIVE: The purpose of this study was to evaluate the safety and efficacy of postoperative administration of prophylactic amiodarone in the prevention of new-onset postoperative atrial fibrillation in patients undergoing coronary artery bypass grafting. METHODS: In this prospective study 157 patients were randomly divided into two groups: 77 patients (amiodarone group) received intravenous amiodarone in a dose of 10 mg/kg/d for postoperative 48 hours. On postoperative day 2 oral amiodarone was started with a dose of 600 mg/d for 5 days, 400 mg/d for the following 5 days, and 200 mg/d for 20 days, and 80 patients received placebo (control group). RESULTS: Preoperative patient characteristics and operative variables were similar in the two groups. Postoperative atrial fibrillation occurred in 8 patients (10.4%) receiving amiodarone and in 20 (25.0%) patients receiving placebo (P =.017). Duration of atrial fibrillation was 12.8 +/- 4.8 hours for the amiodarone group compared with 34.7 +/- 28.7 hours for the control group (P =.003). The maximum ventricular rate during atrial fibrillation was slower in the amiodarone group than in the control group (105.9 +/- 19.1 beats per minute and 126.0 +/- 18.5 beats per minute, respectively, P =.016). The two groups had a similar incidence of complication other than rhythm disturbances (20.8% vs 20.0%, P =.904). Amiodarone group patients had shorter hospital stays than that of control group patients (6.8 +/- 1.7 days vs 7.8 +/- 2.9 days, P =.014). The in-hospital mortality was not different between two groups (1.3% vs 3.8, P =.620). CONCLUSIONS: Postoperative intravenous amiodarone, followed by oral amiodarone, appears to be effective in the prevention of new-onset postoperative atrial fibrillation. It also reduces ventricular rate and duration of atrial fibrillation after coronary artery bypass grafting. It is well tolerated and decreases the length of hospital stay.

Surgical treatment of acute arch dissection.

OBJECTIVES: Acute type A arch dissections are rare and no consensus has been reached on their surgical treatment. We studied perioperative risk factors for mortality in arch dissection patients. METHODS: Between October 1995 and October 2001, 108 patients with acute type A dissection were operated on, of whom 16 had acute arch dissections. Their mean age was 58 +/- 9 (44-77). Surgery involved total arch replacement in 4, hemiarch replacement in 10, and intimal tear repair with pledgeted sutures and ascending aortic replacement in 2. RESULTS: One patient who underwent total arch replacement died intraoperatively due to bleeding. Both patients who underwent ascending aortic replacement and primary repair of arch tears died 2 days postoperatively, 1 due to bleeding, and the other due to multiorgan failure. In-hospital mortality was thus 18.75%, or 3 of 16. All 3 had cardiac tamponade preoperatively. The 13 survivors were discharged after a mean hospital stay of 11 +/- 6 days. Mean follow-up was 38 +/- 25 months, from 3 months to 6 years. One patient died due to graft infection 3 months postoperatively, but the remaining 12 remain in good condition. Univariate predictors of in-hospital mortality were the type of surgery (primary intimal tear repair) (p = 0.027) and preoperative cardiac tamponade (p = 0.007). CONCLUSION: Surgical treatment of acute type A-arch dissections can be done with reasonable mortality and mid-term survival comparable with those of other subgroups with acute type A dissection. As with series of arch dissections, our patient population is too small to draw specific conclusions, but our experience leads us to conclude that the sites of intimal tears should be resected in acute type A arch dissection.