ABSTRACT
In cases of severe atherosclerosis of the ascending aorta, alterations in the standard surgical technique are mandatory. We report mitral valve replacement and coronary artery bypass grafting in a patient with a severely atherosclerotic aorta. Cardiopulmonary bypass was conducted via an arterial cannula in the femoral artery and two single venous cannulas. Coronary artery bypass grafting was performed using bilateral internal thoracic arteries with beating heart in normothermia. The mitral valve was replaced with a mechanical prosthesis during hypothermic fibrillatory arrest.
Subject(s)
Aortic Diseases/surgery , Atherosclerosis/surgery , Calcinosis/surgery , Coronary Artery Bypass , Heart Valve Prosthesis Implantation , Adult , Angina, Unstable/surgery , Aortic Diseases/etiology , Atherosclerosis/complications , Female , Heart Valve Diseases/surgery , Humans , Mitral ValveABSTRACT
We retrospectively analyzed 711 consecutive patients who had isolated coronary artery bypass grafting between January 2000 and December 2004; 572 younger patients (< 70 years) were compared with 139 elderly patients (> or = 70 years). A rapid recovery program based on an anesthetic protocol for early extubation was applied to all patients. The overall hospital mortality rate was 3.3% for the younger group and 4.3% for the elderly group. There were no significant differences in rates of hospital mortality and postoperative complications between the two groups. Early extubation was achieved in significantly more younger (71%) compared to elderly (57%) patients. Rapid recovery with discharge before the 5(th) postoperative day was achieved in 19% of the elderly compared to 48% of the younger patients. Patients in the younger group were discharged from hospital earlier (6.8 +/- 0.3 vs 8.0 +/- 8.5 days). Application of fast-track treatment in an elderly population appears to be a safe and effective approach if used on a selective basis when criteria for early extubation are met.
