ABSTRACT
Bleeding from an aortic suture line or cannula site may be difficult to control, especially in the patient with a fragile or dilated aorta. This method of wrapping a vascular graft around the aorta to relieve tension on the suture line and control bleeding is simple and effective, and it facilitates obtaining the proper tension of the wrapped graft.
Subject(s)
Aorta/surgery , Blood Vessel Prosthesis , Hemostasis, Surgical/methods , Sutures , HumansABSTRACT
Three patients demonstrated severe, central aortic insufficiency noted immediately upon removal of the aortic cross clamp after aortic valve replacement with a bovine pericardial Edwards Magna valve. After maintaining left ventricular decompression, the aortic insufficiency resolved in less than 1 hour. Knowledge of this phenomenon will prevent unnecessary prosthetic valve explantation and re-replacement.
Subject(s)
Aortic Valve Insufficiency/etiology , Bioprosthesis , Heart Valve Prosthesis Implantation/adverse effects , Heart Valve Prosthesis , Aged , Aged, 80 and over , Aortic Valve Insufficiency/diagnostic imaging , Echocardiography, Transesophageal , Female , Humans , Male , Middle Aged , Prosthesis Fitting , Suture Techniques , Time FactorsABSTRACT
BACKGROUND: Few studies have reported long-term outcomes of surgical atrial fibrillation (AF) correction. We perform the Cox-Maze III lesion set with argon-powered cryoenergy (CryoMaze procedure) on all patients with AF presenting for cardiac operations. This study reports long-term clinical results and heart rhythm status. METHODS: Between July 2002 and November 2005, 119 consecutive patients underwent surgical AF correction with the CryoMaze procedure. Mitral valve disease was the primary indication for operation in 66%. AF was continuous in 65%. Rhythm assessment was with 2-week continuous electrocardiographic (ECG) monitoring in 75% of patients and by noncontinuous ECG in the remainder. Median follow-up was 3.2 years and was 98% complete. RESULTS: There was one hospital (0.8%) death. Survival at 3 years was 84%. One perioperative stroke resolved completely. No late strokes occurred. In 4 of 119 patients (4 (3.4%), pacemakers were inserted during the index hospitalization. Median length of stay was 7 days. Overall freedom from AF more than 3 years after operation was 60%. Among patients with preoperative intermittent AF, 85% (28 of 33) were in normal sinus rhythm, and 47% (27 of 58) with continuous AF were in normal sinus rhythm (p < 0.001). CONCLUSIONS: CryoMaze AF correction is safe and is associated with a very low risk of stroke. Rates of normal sinus rhythm at more than 3 years postoperatively were high for patients with intermittent AF and acceptable for those with continuous AF. This experience supports wider application of the CryoMaze to all patients with AF who need cardiac operations.
