Iliac artery aneurysm repair with preservation of a single ectopic pelvic kidney.

An ultrasonographic study in a 60-year-old man incidentally detected an iliac artery aneurysm that gave rise to the renal artery of a single ectopic pelvic kidney. Renal-preservation solution could not be used during surgery, because the unclamped renal vein would have enabled the solution to enter the systemic circulation. Therefore, cold saline solution was infused through the renal ostium, and the kidney was maintained under cold saline immersion. We performed aortoiliac bypass and then implanted the renal artery into the bypass graft. Postoperatively, the patient's serum creatinine level increased; after one year, his renal function was normal. We discuss our use of cold saline solution for renal preservation.

Repeat mitral valve replacement: 30-years' experience.

Prosthetic heart valve dysfunction is an acquired condition that carries a significant risk of emergency surgery. However, the long-term natural history of the condition is not well understood. Between 1974 and 2006, 1535 isolated mitral valve replacements were performed at our hospital (in-hospital mortality 5%). In total, 369 patients needed a second operation (in-hospital mortality 8.1%), while 80 (age 59.8+/-11.4 years) needed a third. The reasons for the third intervention were structural deterioration (67.5%), paravalvular leak (20%) and endocarditis (6.3%). Some 15 patients died in hospital (18.8%). After a mean follow-up period of 17.8 years, 21 patients needed another intervention (i.e., a fourth intervention). The actuarial reoperation-free rate at 20 years was 40.1+/-13.8%. The late mortality rate was 58.5% (18-year survival rate 15.4+/-5.4%). Indications for repeat mitral valve replacement must be judged on an individual basis given the high risk associated with surgery.

Reintervenciones múltiples sobre la válvula mitral: 30 años de experiencia / Repeat mitral valve replacement: 30-years’ experience

La disfunción protésica es una enfermedad adquirida con significativo riesgo quirúrgico inmediato, aunque la historia natural a largo plazo es poco conocida. Entre 1974 y 2006 se realizaron 1.535 recambios mitrales aislados (mortalidad hospitalaria, 5%). Un total de 369 pacientes requirieron una segunda intervención (mortalidad hospitalaria, 8,1%) y 80, una tercera (59,8 ± 11,4 años). Las causas de la tercera intervención fueron deterioro estructural (67,5%), dehiscencia periprotésica (20%) y endocarditis (6,3%). La mortalidad hospitalaria fue 15 (18,8%) pacientes. Tras un seguimiento medio de 17,8 años, 21 pacientes precisaron nueva intervención (cuarta intervención) y la curva actuarial libre de reoperación fue del 40,1% ± 13,8% a 20 años. La mortalidad tardía fue del 58,5% (supervivencia a 18 años, 15,4% ± 5,4%). La indicación de una reintervención reiterativa mitral debe evaluarse de forma individualizada, dado el alto riesgo quirúrgico asociado (AU)

Prosthetic heart valve dysfunction is an acquired condition that carries a significant risk of emergency surgery. However, the long-term natural history of the condition is not well understood. Between 1974 and 2006, 1535 isolated mitral valve replacements were performed at our hospital (in-hospital mortality 5%). In total, 369 patients needed a second operation (in-hospital mortality 8.1%), while 80 (age 59.8[11.4] years) needed a third. The reasons for the third intervention were structural deterioration (67.5%), paravalvular leak (20%), and endocarditis (6.3%). Some 15 patients died in hospital (18.8%). After a mean follow-up period of 17.8 years, 21 patients needed another intervention (ie, a fourth intervention). The actuarial reoperation-free rate at 20 years was 40.1% [13.8%]. The late mortality rate was 58.5% (18-year survival rate 15.4% [5.4%]). Indications for repeat mitral valve replacement must be judged on an individual basis given the high risk associated with surgery (AU)

Surgery for rheumatic tricuspid valve disease: a 30-year experience.

OBJECTIVE: This study was undertaken to assess factors influencing short- and long-term outcomes of surgery for rheumatic disease of the tricuspid valve. METHODS: Between 1974 and 2005, a total of 328 consecutive patients (mean age 51.3 +/- 13.6 years) underwent tricuspid valve surgery for rheumatic disease. There were 12 cases of isolated tricuspid lesion, 199 of triple-valve disease, 114 of tricuspid and mitral valve disease, and 3 of aortic and tricuspid valve disease. Most patients (72%) had predominantly tricuspid regurgitation. Tricuspid valve prosthetic replacement was performed in 31 cases and valve repair in 297. RESULTS: In-hospital mortality was 7.6%. Late mortality was 52.1%, whereas the expected mortality of the Spanish population of the same age was 24.2%. Predictors of in-hospital mortality were male sex, isolated tricuspid lesion, moderate aortic insufficiency, postclamping time, and tricuspid valve replacement. Mean follow-up was 8.7 years (range 1-31 years). Follow-up was 98.9% complete. Predictors of late mortality were age, New York Heart Association functional class IV, postclamping time, and mitral valve replacement. In total, 114 patients required valve reoperation, but only 4 (3.5%) for isolated tricuspid valve dysfunction. At 30 years, actuarial survival was 12.1% +/- 4.4%, actuarial freedom from reoperation was 27.5% +/- 5.8%, and actuarial freedom from valve-related complications was 2.0% +/- 1.3%. CONCLUSION: Organic tricuspid valve disease associated with rheumatic mitral or aortic lesions increases hospital and late mortality, but valve repair compared favorably with valve replacement. Long-term results may be considered acceptable for otherwise incurable valve disease.

[Cardiac surgery in Jehovah's Witnesses. Experience in Santander, Spain]. / Cirugía cardiaca en testigos de Jehová. Experiencia en Santander.

As patients who are Jehovah's Witnesses are against blood transfusion, they are difficult to manage when a cardiac intervention is required. Between 1998 and 2004, all Jehovah's Witness patients with an indication for cardiac surgery (n=10) were operated on by the same multidisciplinary team. The mean fall in hematocrit was 30% during cardiopulmonary bypass, 35% during the postoperative period, and 22% at discharge. One patient required cardiac re-exploration because of sternal bleeding. All patients survived operation and were discharged. At follow-up, 1 patient died due to respiratory failure. Technological developments that reduce bleeding and enable lost blood to be recovered have made it possible to perform operations involving a risk of hemorrhage in Jehovah's Witnesses.

Cirugía cardiaca en testigos de Jehová. Experiencia en Santander / Cardiac surgery in Jehovah’s witnesses. Experience in Santander, Spain

Los testigos de Jehová constituyen una población de difícil tratamiento para las intervenciones de cirugía cardiaca. Entre 1998 y 2004, todos los pacientes testigos de Jehová con indicación de cirugía cardiaca (n = 10) fueron intervenidos por un mismo equipo. El descenso medio del hematocrito fue, durante la circulación extracorpórea, del 30%, durante el postoperatorio, del 35% y en el alta, del 22%. Un paciente precisó una reintervención precoz por sangrado importante de origen esternal. Todos los pacientes fueron dados de alta y durante el seguimiento un enfermo falleció de causa respiratoria. Las medidas para disminuir y recuperar la pérdida de sangre permiten realizar intervenciones de riesgo hemorrágico en pacientes testigos de Jehová (AU)

As patients who are Jehovah's Witnesses are against blood transfusion, they are difficult to manage when a cardiac intervention is required. Between 1998 and 2004, all Jehovah's Witness patients with an indication for cardiac surgery (n=10) were operated on by the same multidisciplinary team. The mean fall in hematocrit was 30% during cardiopulmonary bypass, 35% during the postoperative period, and 22% at discharge. One patient required cardiac re-exploration because of sternal bleeding. All patients survived operation and were discharged. At follow-up, 1 patient died due to respiratory failure. Technological developments that reduce bleeding and enable lost blood to be recovered have made it possible to perform operations involving a risk of hemorrhage in Jehovah's Witnesses (AU)