Intracardiac expression of markers of endothelial damage/dysfunction, inflammation, thrombosis, and tissue remodeling, and the development of postoperative atrial fibrillation.

BACKGROUND: Atrial fibrillation (AF) is a common complication of coronary artery bypass grafting (CABG), and may have an inflammatory and/or thrombotic etiology. We sought to determine the expression of inflammatory (interleukin [IL]-6), thrombotic (tissue factor and von Willebrand factor [VWF]) and remodeling (matrix metalloproteinase [MMP]-9 and tissue inhibitor of metalloproteinase [TIMP]-1) markers by left atrial appendage (LAA) and right atrial appendage (RAA) tissue in the prediction of postoperative AF. We determined whether the tissue expression of markers of certain different pathophysiologic mechanisms predicted the development of AF after CABG. METHODS: LAA and RAA tissue was excised during CABG in 100 patients free of AF and inflammation. Tissue marker expression was quantified by immunohistochemistry and was related to 30-day postoperative AF. RESULTS: Overall, there were no significant differences in staining intensity of any marker between LAA tissue and RAA tissue. However, more intense expression of VWF by LAA tissue predicted the 30 patients with postoperative AF as compared with those free of AF (P = 0.006). IL-6, MMP-9 and TIMP-1 expression by RAA and LAA epicardial tissue was stronger than expression by endocardium or cardiomyocytes (all P < 0.025) but failed to predict AF. CONCLUSION: In this study, one of the largest to investigate tissue expression of pathophysiologic markers in relation to postoperative AF, we show that more intense expression of VWF by LAA tissue is a significant predictor of postoperative AF. This points towards a possible role of endothelial damage/dysfunction (as reflected by VWF changes) in the pathogenesis of postoperative AF.

Ross operation--immediate and mid-term results.

BACKGROUND: The Ross procedure has resolved the major problem in the management of aortic valve disease in the young, The operation can be performed in childhood and procedes an ideal valve substitute, which does not require anticoagulation, has growth potential and is free from degeneration. METHODS: Short- and mid-term results of 45 patients after Ross procedure (December 1993 through April 1999) were reviewed. The aim of this study was to evaluate postoperative haemodynamic performance of this procedure, to asses the impact of modifications on postoperative results, and to make inferences that may improve results. RESULTS: There were four early deaths (9%), no late deaths and no reoperations. Thirty-four patients had no or trivial symptoms, six patients had mild symptoms and one patient, moderate regurgitation of neo-aortic valve at the last echocardiographic study. Stenosis was not present at rest or during exercise. An obvious regression of left ventricle hypertrophy was detected (248+/-94-10+/-34 g/m). Reinforcement of the proximal suture line of the pulmonary autograft with pericardial strips does not restrict the growth of the aortic annulus. Dilatation of the aortic root was detected in all patients. The mean gradient through pulmonary homograft was 11.5 mmHg. CONCLUSIONS: The Ross procedure provides optimal haemodynamic function from the neo-aortic valve, leading to regression of left ventricular hypertrophy and near normal life style, without anticoagulation. Dilatation of the neo-aortic root diameter postoperatively was not associated with progressing of regurgitation. Concern still exists over future valve function, particularly in patients with a diagnosis of bicuspid dilated incompetent aortic valves.

Optimal approach for mitral valve surgery.

It seems that mitral valve (MV) replacement technique is already standardized but still under discussion is the surgical approach. At Heart Surgery Clinic of Vilnius University MV replacement was started in 1970 (our total experience in valve surgery is 4396 operations). The most popular surgical approach was through left atrium (LA) from the right side. In cases with small atrium we used right atrial and transseptal and transverse transeptal biatrial (TTBA) approach. Left atrium approach is quite useful in many cases except those with small LA, LV hypertrophy and heart rotation when it can result a greater trauma for the heart, extended time of operation and, possibly, reduced performance after it. From September 1992 till May 1993 we used extended vertical transseptal (EVT) approach in 18 patients for MV replacement or repair, mitral and aortic valve replacement was performed for 5 patients, mitral valve replacement and tricuspid valvuloplasty for 13 patients, 5 patients had mitral valve reoperations and for 3 patients aortocoronary by-pass performed additionally. The technique used was exactly as proposed by O. Alfieri et al, and incorporated bicaval cannulation and vertical transseptal incision extended into the roof of LA. From the first operation it became clear that this approach was superior to all others we had used during 20 years, since it gives perfect visibility of mitral valve, does not require retractors (only traction sutures are applied) and allows even to very easily use the continuous suture for valve fixation. Size of LA is no longer important.(ABSTRACT TRUNCATED AT 250 WORDS)