Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 20 de 23
Filter
1.
Kyobu Geka ; 77(1): 15-19, 2024 Jan.
Article in Japanese | MEDLINE | ID: mdl-38459840

ABSTRACT

We retrospectively study the outcome of left atrial appendage (LAA) preserving maze procedure, focus on thrombus formation in left atrium( LA), postoperative stroke, and LA function. PATIENTS AND METHODS: We studied 131 patients (mean age, 68.2y;77 men and 54 women) who underwent maze procedure for atrial fibrillation( Af) between 2008 and 2020. Full maze was performed for 116 patients with long-standing persistent Af or persistent Af. Pulmonary vein isolation alone was performed for 15 patients with paroxysmal Af. The mean follow-up period was 2.9( 10.1-0.4) years. RESULTS: In perioperative results, there were no death, cerebral infarction, and reoperation in this series. At discharge, 1 year, 3 years, 5 years, and 10 years after the surgery, sinus rhythm was maintained in 92%, 87%, 83%, 77%. Pacemaker was implanted in 8( early 3, late 5) patients. Despite adequate anticoagulant therapy, one patient developed cerebral infarction a month postoperatively. In other patients, there was no cerebral infarction in short-term nor long-term. CONCLUSIONS: The LAA preserving maze procedure was not a risk factor of cerebral infarction under appropriate medication. However, close follow-up is essential.


Subject(s)
Atrial Appendage , Atrial Fibrillation , Catheter Ablation , Male , Humans , Female , Aged , Atrial Appendage/surgery , Treatment Outcome , Maze Procedure , Retrospective Studies , Atrial Fibrillation/surgery , Atrial Fibrillation/etiology , Cerebral Infarction/etiology , Catheter Ablation/adverse effects
2.
J Cardiol ; 71(3): 230-236, 2018 03.
Article in English | MEDLINE | ID: mdl-28986069

ABSTRACT

BACKGROUND: There is a paucity of data that demonstrates a clinical impact of anatomical measurements of the aortic annulus by three-dimensional (3D) transesophageal echocardiography (TEE) on surgical aortic valve replacement (AVR). The aim of this study is to validate the accuracy of 3D TEE measurements compared with the direct intraoperative annular diameter and to investigate an impact of 3D TEE on a prediction of AVR with aortic annular enlargement (AAE). METHODS AND RESULTS: We retrospectively enrolled 61 patients who underwent both two-dimension (2D) and 3D TEE and transthoracic echocardiography (TTE) before AVR. The annular diameters were measured noninvasively with 2D TEE (D2D) and TTE (DTTE) in a classical manner and the area- and perimeter-derived annular diameters (Darea, Dperim) were measured from using 3D TEE analysis. Intraoperative annular diameter was measured with the manufacture's sizer (Dintraope). Darea showed the best agreement with Dintraope in the Bland-Altman analysis. Darea, Dperim, D2D, and DTTE correlated well with Dintraope (r=0.821, 0.820, 0.532, and 0.610, respectively; all p<0.001). Three patients underwent AVR with AAE and the specificity of Dperim for prediction of AAE was significantly higher than D2D (p=0.008). CONCLUSIONS: 3D TEE measurement of aortic annular diameter showed better agreement with the direct intraoperative measurement than 2D TEE and TTE measurements. 3D TEE measurement could predict AVR with AAE more accurately than 2D TEE and TTE measurements.


Subject(s)
Aortic Valve Stenosis/diagnostic imaging , Aortic Valve/diagnostic imaging , Aortic Valve/pathology , Echocardiography, Three-Dimensional/statistics & numerical data , Echocardiography, Transesophageal/statistics & numerical data , Aged , Aortic Valve/surgery , Aortic Valve Stenosis/pathology , Aortic Valve Stenosis/surgery , Echocardiography, Three-Dimensional/methods , Echocardiography, Transesophageal/methods , Female , Heart Valve Prosthesis Implantation/methods , Humans , Male , Middle Aged , Organ Size , Reproducibility of Results , Retrospective Studies
4.
Circ J ; 81(5): 689-693, 2017 Apr 25.
Article in English | MEDLINE | ID: mdl-28179595

ABSTRACT

BACKGROUND: We evaluated the outcomes of totally endoscopic minimally invasive surgery for atrial septal defect (ASD) using a glutaraldehyde-treated autologous pericardial patch in the transcatheter interventional era.Methods and Results:We retrospectively reviewed 37 consecutive patients who underwent totally endoscopic ASD closure with a glutaraldehyde-treated autologous pericardial patch between June 2011 and April 2015. All patients had been deferred from catheter-based intervention for clinical or anatomical reasons. We analyzed operative outcomes and postoperative echocardiographic data. The mean age was 45.7±16.5 years, and 25 patients (67.6%) were women. The mean ratio of pulmonary to systemic flow was 2.4±0.7. Six patients (16.2%) underwent concomitant tricuspid valve repair, and 3 patients (8.1%) underwent concomitant atrial fibrillation surgery. There were no operative deaths, and the median length of hospital stay was 5 days. Postoperative echocardiography revealed trivial residual shunt in 1 patient. During the follow-up period, there were no re-interventions for ASD or readmission for heart failure. Follow-up echocardiography revealed no recurrent shunt or calcification of the autologous pericardial patch. CONCLUSIONS: Totally endoscopic ASD closure with a glutaraldehyde-treated autologous pericardial patch demonstrated excellent outcomes. It is a useful option for patients with unfavorable anatomy or other reasons excluding transcatheter intervention.


Subject(s)
Endoscopy/methods , Glutaral/therapeutic use , Heart Septal Defects, Atrial/surgery , Pericardium/transplantation , Adult , Autografts , Cardiac Surgical Procedures/methods , Female , Humans , Male , Middle Aged , Minimally Invasive Surgical Procedures/methods , Retrospective Studies , Tissue Transplantation/methods , Treatment Outcome
5.
Ann Thorac Surg ; 103(2): e171-e173, 2017 Feb.
Article in English | MEDLINE | ID: mdl-28109382

ABSTRACT

An 80-year-old man with symptomatic severe aortic stenosis underwent transcatheter aortic valve replacement. Postoperatively, the patient was hemodynamically stable without inotropic or mechanical support. Approximately 30 hours after the procedure, he developed severe abdominal pain, and a blood test result showed elevated serum lactate level. We suspected nonocclusive mesenteric ischemia and performed emergency selective angiography of the superior mesenteric artery, which showed vasospasm. We confirmed the diagnosis of nonocclusive mesenteric ischemia, and it was treated successfully with intraarterial infusion of vasodilators into the superior mesenteric artery.


Subject(s)
Computed Tomography Angiography/methods , Mesenteric Artery, Superior/drug effects , Mesenteric Ischemia/diagnostic imaging , Transcatheter Aortic Valve Replacement/adverse effects , Vasodilator Agents/therapeutic use , Aged, 80 and over , Aortic Valve Stenosis/diagnostic imaging , Aortic Valve Stenosis/surgery , Follow-Up Studies , Humans , Infusions, Intra-Arterial , Male , Mesenteric Artery, Superior/diagnostic imaging , Mesenteric Ischemia/drug therapy , Mesenteric Ischemia/etiology , Postoperative Complications/diagnostic imaging , Postoperative Complications/drug therapy , Postoperative Complications/physiopathology , Risk Assessment , Severity of Illness Index , Transcatheter Aortic Valve Replacement/methods , Treatment Outcome
6.
J Vasc Surg Cases Innov Tech ; 3(2): 57-59, 2017 Jun.
Article in English | MEDLINE | ID: mdl-29349377

ABSTRACT

Celiac artery (CA) coverage during thoracic endovascular aortic repair has been demonstrated to be a feasible and effective strategy for selected cases. However, there is a potential risk of ischemic complications due to CA coverage in patients with certain types of hereditary hemorrhagic telangiectasia (HHT). Herein, we report a case of thoracoabdominal aortic rupture in a patient with HHT that was successfully treated with emergency thoracic endovascular aortic repair covering the CA preceded by hepatic artery bypass. We also review the hepatic circulatory derangements and unique considerations in the surgical management of HHT.

8.
Ann Thorac Surg ; 102(2): e147-9, 2016 Aug.
Article in English | MEDLINE | ID: mdl-27449452

ABSTRACT

We observed a case of intraoperative type A dissection during open descending and thoracoabdominal aortic replacement. It is difficult to obtain optimal access to the ascending aorta and aortic root through a left thoracotomy. Transection of the pulmonary trunk provided excellent exposure of the ascending aorta and aortic root, and we successfully managed this devastating adverse event.


Subject(s)
Aortic Aneurysm, Thoracic/diagnostic imaging , Aortic Aneurysm, Thoracic/surgery , Aortic Dissection/surgery , Intraoperative Complications/surgery , Thoracotomy/methods , Adult , Anastomosis, Surgical/methods , Aortic Dissection/diagnostic imaging , Blood Vessel Prosthesis Implantation/methods , Cardiopulmonary Bypass/methods , Emergency Treatment , Female , Follow-Up Studies , Humans , Intraoperative Complications/diagnostic imaging , Risk Assessment , Tomography, X-Ray Computed/methods , Treatment Outcome , Vascular Surgical Procedures/methods
9.
Ann Thorac Surg ; 101(5): e179-81, 2016 May.
Article in English | MEDLINE | ID: mdl-27106474

ABSTRACT

Leaflet resection with sliding valvuloplasty or additional chordal replacement is a standard technique for very large posterior leaflet prolapse. Regular chordal replacement without resection is simpler than those techniques. However, it may not reduce the leaflet height enough to avoid systolic anterior motion. In our technique, two pairs of neochordae are placed on the middle portion of the prolapsing scallop, which fixes the prolapse, reduces the functional height of the posterior leaflet, and blocks the leaflet tip from moving forward. This simple nonresectional technique can be easily performed with minimally invasive approaches. Postoperative echocardiography shows excellent leaflet motion and deep coaptation.


Subject(s)
Chordae Tendineae/surgery , Minimally Invasive Surgical Procedures/methods , Mitral Valve Insufficiency/surgery , Mitral Valve Prolapse/surgery , Aged , Echocardiography , Humans , Middle Aged
10.
Ann Thorac Surg ; 100(3): e59-61, 2015 Sep.
Article in English | MEDLINE | ID: mdl-26354669

ABSTRACT

Obtaining excellent exposure of the papillary muscles is challenging in minimally invasive mitral valve repair. We have developed a simple and effective technique using a sterile paper ruler. The ruler is cut to the proper length (8 to 12 cm) depending on the valve size, then rolled and sutured. The rolled ruler, 7 to 11 cm in circumference, is placed inside the mitral leaflets. This technique provides excellent exposure of the papillary muscles without damaging the leaflets and prevents chordal injury during artificial chordal implantation.


Subject(s)
Endoscopy/economics , Endoscopy/methods , Heart Valve Diseases/surgery , Mitral Valve/surgery , Papillary Muscles , Cardiac Surgical Procedures/economics , Cardiac Surgical Procedures/methods , Humans
11.
J Echocardiogr ; 13(2): 69-71, 2015 Jun.
Article in English | MEDLINE | ID: mdl-26184641

ABSTRACT

A 70-year-old man with a diastolic Levine V/VI musical murmur came to our department. Doppler color-flow imaging showed eccentric severe aortic regurgitation. M-mode echocardiography demonstrated fluttering of the anterior mitral leaflet and fine tremors at the aortic root. The curved M-mode representation of the myocardial strain rate showed that the basal septum was encoded in a mixture of blue and red spots during diastole, showing massive basal septal vibration. In the present case, the force of the regurgitant flow might have caused vibration of the basal septum, thereby possibly leading to distinct thrill.


Subject(s)
Aortic Valve Insufficiency/diagnostic imaging , Mitral Valve Insufficiency/diagnosis , Aged , Cardiac Output , Diastole , Echocardiography , Echocardiography, Doppler , Heart Murmurs , Humans , Male , Mitral Valve
12.
J Cardiol Cases ; 12(1): 8-11, 2015 Jul.
Article in English | MEDLINE | ID: mdl-30534268

ABSTRACT

We report a case of right ventricular (RV) diastolic dysfunction due to a large hematoma posterior to the left ventricle (LV) after cardiac surgery. An 80-year-old woman underwent cardiac surgery. After surgery, her physical findings revealed right heart failure. Localized hematoma posterior to the pericardial space and the RV compression to the sternum were shown by computed tomography. Transthoracic Doppler echocardiography demonstrated restrictive physiology of the RV although there was no evidence of constrictive pericarditis. These findings suggest that RV diastolic dysfunction could have occurred due to the hematoma posterior to the LV. Since pleural effusion had persisted despite medical therapy, the hematoma was removed surgically. Soon after surgery, dyspnea and pretibial edema were diminished; bilateral pleural effusion dramatically disappeared. RV diastolic dysfunction estimated by echocardiography was improved and RV compression disappeared. We speculate that there are two physiological mechanisms for the RV compression: (1) the localized hematoma elevated the intrapericardial pressure and (2) the hematoma shifted the entire heart to the sternum. In conclusion, this is the first case report of RV diastolic dysfunction due to large hematoma posterior to the LV. .

13.
Ann Thorac Cardiovasc Surg ; 21(1): 66-71, 2015.
Article in English | MEDLINE | ID: mdl-24583703

ABSTRACT

PURPOSE: We investigated the influence of intraoperative continuous tranexamic acid (TA) infusion on the amount of blood transfusion required in emergency surgery for type A acute aortic dissection. METHODS: The study was based on the data of 55 consecutive patients who underwent surgery for type A acute aortic dissection. The patients were divided into 2 groups for comparison: Group T, consisting of 26 patients who received intraoperative continuous infusion of TA, and Group N, consisting of 29 patients who did not receive TA infusion during the surgery. RESULTS: The mean amounts of blood transfusion required during and after surgery were compared between the 2 groups: they were 10.5 ± 8.7 and 16.2 ± 10.0 units of mannitol-adenine-phosphate-added red cell concentrate, 9.3 ± 8.6 and 17.1 ± 10.0 units of fresh frozen plasma, and 20.4 ± 12.2 and 29.7 ± 14.9 units of platelet concentrate, respectively, in Groups T and N. Thus, the amount of each of these blood products required was significantly reduced in Group T. CONCLUSIONS: During emergency surgery for type A acute aortic dissection, continuous infusion of TA resulted in a significant reduction in the amount of blood transfusion required.


Subject(s)
Antifibrinolytic Agents/administration & dosage , Aortic Aneurysm, Thoracic/surgery , Aortic Dissection/surgery , Blood Loss, Surgical/prevention & control , Blood Vessel Prosthesis Implantation , Tranexamic Acid/administration & dosage , Acute Disease , Aged , Aortic Dissection/blood , Aortic Dissection/diagnosis , Antifibrinolytic Agents/adverse effects , Aortic Aneurysm, Thoracic/blood , Aortic Aneurysm, Thoracic/diagnosis , Blood Transfusion , Blood Vessel Prosthesis Implantation/adverse effects , Emergencies , Female , Humans , Infusions, Parenteral , Male , Middle Aged , Retrospective Studies , Tranexamic Acid/adverse effects , Treatment Outcome
14.
Kyobu Geka ; 67(3): 190-3, 2014 Mar.
Article in Japanese | MEDLINE | ID: mdl-24743527

ABSTRACT

We report a case of aortic valve replacement (AVR) and mitral valve replacement (MVR) in a patient with severe left ventricular dysfunction who had undergone right pneumonectomy for lung cancer 14 years previously. A 64-year-old man had cathecolamine-dependent heart failure due to bicuspid aortic valve stenosis, functional mitral valve regurgitation and impaired left ventricular function (left ventricular ejection fraction 13%)because of dilated cardiomyopathy. AVR and MVR were performed using St. Jude Medical mechanical valves with right thoracotomy because the heart had shifted to the right side. Poor left ventricular function and postoperative atrial fibrillation made it difficult to control low-output syndrome, but prolonged use of intra-aortic balloon pumping improved it gradually. Intraaortic balloon pumping( IABP) was removed 34 days after the operation, the respirator was removed with tracheotomy 63 days postoperatively, and the patient was discharged on the 177th postoperative day. Careful preoperative assessment and perioperative control of heart failure are important components of successful clinical management.


Subject(s)
Aortic Valve/surgery , Heart Failure/complications , Mitral Valve/surgery , Pneumonectomy , Thoracotomy , Ventricular Dysfunction, Left/complications , Heart Valve Diseases/etiology , Heart Valve Diseases/surgery , Heart Valve Prosthesis Implantation , Humans , Male , Middle Aged , Postoperative Complications
15.
Ann Thorac Cardiovasc Surg ; 20 Suppl: 821-4, 2014.
Article in English | MEDLINE | ID: mdl-23445788

ABSTRACT

A rare case of an aneurysmal Kommerell's diverticulum in a right-sided aortic arch was successfully treated using a hybrid procedure comprising total arch replacement and percutaneous stent grafting. A 65-year-old man with dysphagia was diagnosed with an ectatic right-sided aortic arch and a saccular aneurysm of the Kommerell's diverticulum. Since its radical resection during a single surgery was unfeasible because of its complex configuration, a 2-stage procedure was adopted.


Subject(s)
Aneurysm/surgery , Aorta, Thoracic/abnormalities , Aortic Aneurysm, Thoracic/surgery , Blood Vessel Prosthesis Implantation/methods , Cardiovascular Abnormalities/surgery , Deglutition Disorders/surgery , Diverticulum/surgery , Endovascular Procedures/methods , Subclavian Artery/abnormalities , Aged , Aneurysm/complications , Aneurysm/diagnosis , Aortic Aneurysm, Thoracic/complications , Aortic Aneurysm, Thoracic/diagnosis , Cardiovascular Abnormalities/complications , Cardiovascular Abnormalities/diagnosis , Deglutition Disorders/complications , Deglutition Disorders/diagnosis , Diverticulum/complications , Diverticulum/diagnosis , Humans , Male , Subclavian Artery/surgery
16.
J Heart Valve Dis ; 22(4): 567-74, 2013 Jul.
Article in English | MEDLINE | ID: mdl-24224422

ABSTRACT

BACKGROUND AND AIM OF THE STUDY: Prosthetic valve endocarditis (PVE) is considered a time-related event. The study aim was to compare the clinical characteristics and outcomes of early- and late-onset PVE, and to investigate potential preventive measures for each condition. METHODS: A total of 47 consecutive patients undergoing surgery for PVE between January 1986 and December 2011 were analyzed retrospectively, and classified as an early-onset group (n = 26; PVE occurring within 12 months after previous surgery) and late-onset group (n = 21; PVE occurring after 12 months). RESULTS: The prosthetic valve position significantly affected the incidence of endocarditis: 21 cases (80.7%) in the early-onset group had infected aortic prostheses, while 18 (85.7%) in the late-onset group had infected mitral prostheses (p = 0.028). PVE significantly affected bioprosthetic valves in the early-onset group (18 cases, 69.2%) and mechanical valves in the late-onset group (17 cases, 80.9%) (p < 0.01). Staphylococcus spp. infections were predominant in the early-onset group (21 cases, 80.7%), and Streptococcus spp. in the late-onset group (five cases, 23.8%) (p = 0.03). Operative deaths occurred in both the early-onset (n = 6; 23.0%) and late-onset (n = 2; 9.5%) groups (p = 0.11). The long-term mortality in the early-onset and late-onset groups, respectively, was 40.3 +/- 17.7% and 85.1 +/- 7.9% at 10 years, and 40.3 +/- 17.7% and 72.9 +/- 13.1% at 15 years (p 0.047). Freedom from recurrent endocarditis after two years in the early- and late-onset groups, respectively, was 67.8 +/- 10.1% and 88.8 +/- 7.4% (p = 0.048). CONCLUSION: Clinical characteristics and outcomes differed significantly between early- and late-onset PVE. The clinical outcomes of patients with early PVE tend to be serious, and therefore stringent care should be taken to avoid contamination during the initial surgery and hence to reduce the incidence of the condition.


Subject(s)
Endocarditis, Bacterial , Heart Valve Diseases/surgery , Heart Valve Prosthesis Implantation/adverse effects , Heart Valve Prosthesis/adverse effects , Heart Valves , Prosthesis-Related Infections , Aged , Bacteria/classification , Endocarditis, Bacterial/etiology , Endocarditis, Bacterial/microbiology , Endocarditis, Bacterial/mortality , Endocarditis, Bacterial/surgery , Female , Heart Valve Diseases/classification , Heart Valve Diseases/diagnosis , Heart Valve Prosthesis/classification , Heart Valve Prosthesis Implantation/methods , Heart Valves/microbiology , Heart Valves/surgery , Humans , Incidence , Japan , Kaplan-Meier Estimate , Male , Middle Aged , Prognosis , Prosthesis-Related Infections/etiology , Prosthesis-Related Infections/microbiology , Prosthesis-Related Infections/mortality , Prosthesis-Related Infections/surgery , Retrospective Studies , Risk Factors , Time Factors , Treatment Outcome
17.
Kyobu Geka ; 66(11): 948-51, 2013 Oct.
Article in Japanese | MEDLINE | ID: mdl-24105108

ABSTRACT

OBJECTIVE: We study the validity of surgical procedure for total aortic arch replacement according to the atherosclerosis in the aortic arch. METHODS: From 2007 to June 2013, Consecutive 185 patients underwent total aortic arch replacement for thoracic aortic anuerysm. We studied 135 patients[96 males 72.1 year(38~89year)]except emergency operation. We assessed the atherosclerosis in the aortic arch by preoperative enhanced computed tomography (CT)scan and intraoperative epiaortic echocardiography. Based on the degree of atherosclerosis in the aortic arch, we divided into 2 groups:group 1(G1)included 97 patients with mild or moderate atherosclerosis and group 2 (G2) 38 patients with severe atherosclerosis. We used ascending aorta as arterial cannulation site in G1 and axillary artery with 8 mm graft in G2 .We compared with both groups for preoperative comorbidities and outcomes( mortality and stroke). RESULTS: Three patients died in the hospital (2%). In-hospital neurological events occurred in 12 patients, including major stroke in 4 patients, minor stroke in 4 patients and asymptomatic convulsion in 4 patients, although they were transient and clear before discharge except major stroke. There were no statistically significant differences in preoperative characteristics, cardiopulmonary bypass, brain protection, mortality, and neurological events between the 2 groups. There was a statistically difference in operation time( 388.8 minutes vs 448.5 minutes, p<0.01), intensive care unit( ICU) stay( 3.1 day vs 6.5 days, p<0.05) and hospital stay( 19.2 days vs 28.0 days, p<0.05). CONCLUSIONS: We selected surgical procedure for total aortic arch replacement (TAR) according to atherosclerosis in the aortic arch. Although the rate of stroke was largely acceptable, we much need to be improved in prevention of stroke.


Subject(s)
Aorta, Thoracic/surgery , Aortic Aneurysm, Thoracic/surgery , Atherosclerosis/surgery , Adult , Aged , Aged, 80 and over , Blood Vessel Prosthesis Implantation , Cardiopulmonary Bypass , Female , Humans , Male , Middle Aged , Stroke/prevention & control , Treatment Outcome
18.
Gen Thorac Cardiovasc Surg ; 61(5): 292-5, 2013 May.
Article in English | MEDLINE | ID: mdl-22893319

ABSTRACT

A 65-year-old man with an isolated aneurysm of the proximal right subclavian artery (SCA) (diameter, 50 mm) was successfully treated with a deliberate surgical strategy described here. Because of the occluded left vertebral artery (VA) and poor development of the circle of Willis, the distal portion of the right SCA was bypassed from the ascending aorta before resecting the aneurysm in order to maintain blood flow to the brain through the right VA. Consequently, the patient recovered without neurological complications. We conclude that conventional surgery remains effective for complex vascular diseases even in the era of advanced endovascular surgeries.


Subject(s)
Aneurysm/surgery , Aorta/surgery , Subclavian Artery/surgery , Aged , Cerebrovascular Circulation , Humans , Male
19.
J Heart Valve Dis ; 22(5): 704-12, 2013 Sep.
Article in English | MEDLINE | ID: mdl-24383385

ABSTRACT

BACKGROUND AND AIM OF THE STUDY: The study aim was to comprehend the outcomes of surgery for prosthetic valve endocarditis (PVE) over 25 years and to identify predictors for patient survival. METHODS: A total of 47 consecutive patients (19 males, 28 females; mean age 67.0 +/- 11.5 years) whounderwent surgery for PVE between 1986 and 2011 was analyzed. Typically, PVE appeared at 4.2 +/- 6.2 years after valve replacement. Preoperative and postoperative clinical variables were evaluated; the mean follow up was 6.4 +/- 5.3 years. RESULTS: The incidence of PVE was 3.9% for 1,185 cases of valve replacement through the study period. Operative mortality was 17.0%. NYHA functional class IV (p = 0.01), preoperative shock (p = 0.03) and renal failure (p = 0.02) were each independent predictors of operative mortality. Survival was 69.1 +/- 9.3% at 10 years and 59.2 +/- 12.1% at both 15 and 20 years. Preoperative impaired left ventricular function (p = 0.02) and preoperative renal failure (p = 0.04) were independent predictors of late mortality. Freedom from recurrent PVE remained at 82.5 +/- 6.0% from two years up to 20 years after surgery. Initial infective endocarditis (p = 0.03) and postoperative heart failure (p = 0.04) were predictors of recurrent PVE. Freedom from reoperation was 84.8 +/- 5.7% at 10 years, and 72.6 +/- 12.2% at both 15 and 20 years. CONCLUSION: This extensive examination revealed that critical preoperative conditions determine not only short-term but also long-term mortality after surgery to treat PVE. Hence, a timely surgical intervention and close follow up are crucial for patient survival.


Subject(s)
Endocarditis, Bacterial/epidemiology , Heart Valve Prosthesis/adverse effects , Prosthesis-Related Infections/epidemiology , Adult , Aged , Aged, 80 and over , Endocarditis, Bacterial/etiology , Female , Follow-Up Studies , Hospital Mortality/trends , Humans , Incidence , Japan/epidemiology , Male , Middle Aged , Prosthesis-Related Infections/etiology , Recurrence , Reoperation , Retrospective Studies , Risk Factors , Time Factors
20.
Eur J Cardiothorac Surg ; 41(4): e32-6, 2012 Apr.
Article in English | MEDLINE | ID: mdl-22290927

ABSTRACT

OBJECTIVES: We evaluated the durability of aortic valve preservation with root reconstruction for acute type A aortic dissection (AAAD). METHODS: From January 2002 to March 2011, 140 patients [70 males, 68 ± 12 (SD) years] underwent emergency operation for AAAD. The aortic valve was preserved and one or more Valsalva sinuses were reconstructed. Techniques used for reconstruction were valve resuspension and additional reinforcement of the aortic root with Teflon felt patches, and gelatin-resorcinol-formaldehyde-glue (GRF-glue) was used for mending the dissection. The mean follow-up period was 44.0 ± 26.2 months. We classified the degree of aortic regurgitation (AR) into four grades (0, 1+, 2+ and 3+) using echocardiography. Based on a retrospective analysis of pre-operative echocardiographic findings, the 127 survivors were divided into two groups: group 1 (G1) included 98 patients with 0 or 1+ AR, and group 2 (G2) 29 patients with 2+ or 3+ AR. In addition, we measured the post-operative native aortic root dimension of AAAD patients with use of echocardiography or CT scan. RESULTS: The operative mortality rate was 9.3% (13/140). Freedom from aortic root re-operation was 100%. Aortic root pseudoaneurysm formation and severe AR requiring aortic valve replacement did not occur. Pre-operative AR of 0.2 ± 0.4 in G1 did not deteriorate (0.5 ± 0.5 at discharge, 0.4 ± 0.4 at follow-up). Meanwhile, pre-operative AR of 2.4 ± 0.5 in G2 improved to 0.6 ± 0.5 (P < 0.05) at discharge and 1.0 ± 0.6 (P < 0.05) at follow-up. The native aortic root dimension in G2 at follow-up was significantly larger than G1 (36.0 ± 4.7 vs. 33.9 ± 5.0 mm). CONCLUSIONS: Aortic valve preservation and root reconstruction appear to be an appropriate surgical approach to AAAD.


Subject(s)
Aortic Aneurysm/surgery , Aortic Dissection/surgery , Aortic Valve/surgery , Blood Vessel Prosthesis Implantation/methods , Acute Disease , Aged , Aged, 80 and over , Aortic Dissection/complications , Aortic Dissection/pathology , Aorta/pathology , Aorta/surgery , Aortic Aneurysm/complications , Aortic Aneurysm/pathology , Aortic Valve Insufficiency/diagnostic imaging , Aortic Valve Insufficiency/etiology , Blood Vessel Prosthesis Implantation/adverse effects , Echocardiography, Transesophageal , Emergencies , Epidemiologic Methods , Female , Humans , Male , Middle Aged , Sinus of Valsalva/surgery , Treatment Outcome
SELECTION OF CITATIONS
SEARCH DETAIL
...