RESUMO
Experience with a new operation for patients with aortic valve disease and aneurysm or dissection of the ascending aorta is described. Twenty-four patients aged 66-87 years were operated on using a subcoronary implantation technique with a stentless aortic valve bioprosthesis and an extension using a vascular tube prosthesis. No major adverse cardiac events were observed in the postoperative period. This operation offers a safe alternative to the technically more demanding procedures of composite bioprosthetic ascending aortic replacement or full root replacement.
Assuntos
Aneurisma Aórtico/cirurgia , Dissecção Aórtica/cirurgia , Valva Aórtica/cirurgia , Bioprótese , Implante de Prótese Vascular/instrumentação , Prótese Vascular , Doenças das Valvas Cardíacas/cirurgia , Implante de Prótese de Valva Cardíaca/instrumentação , Próteses Valvulares Cardíacas , Idoso , Idoso de 80 Anos ou mais , Dissecção Aórtica/complicações , Dissecção Aórtica/patologia , Aneurisma Aórtico/complicações , Aneurisma Aórtico/patologia , Valva Aórtica/patologia , Implante de Prótese Vascular/efeitos adversos , Feminino , Doenças das Valvas Cardíacas/complicações , Doenças das Valvas Cardíacas/patologia , Implante de Prótese de Valva Cardíaca/efeitos adversos , Humanos , Imageamento por Ressonância Magnética , Masculino , Desenho de Prótese , Resultado do TratamentoRESUMO
Subcoronary implantation of the Medtronic stentless bioprosthesis and an extension using a vascular tube prosthesis provide a safer alternative to the more invasive conventional composite graft replacement or a full root replacement using a homograft or a stentless valve. The advantage lies in eliminating the need for coronary mobilisation and anastomosis which actually lead to the increased risk in those procedures.
Assuntos
Valva Aórtica/cirurgia , Bioprótese , Doenças das Valvas Cardíacas/cirurgia , Implante de Prótese de Valva Cardíaca/métodos , Idoso , Idoso de 80 Anos ou mais , Doenças da Aorta/complicações , Doenças da Aorta/cirurgia , Doenças das Valvas Cardíacas/complicações , Próteses Valvulares Cardíacas , Humanos , Pessoa de Meia-Idade , Resultado do TratamentoRESUMO
BACKGROUND: The aim of this experimental study was to compare the protective efficacy of the cardioplegic solutions Celsior and Custodiol. Canine hearts were examined with regard to energy metabolism and early postischemic recovery after 8 or 12 hours of ischemia at 5 degrees C. METHODS: Canine hearts were preserved with Celsior or Custodiol (each n = 19). Five hearts of each group were used to determine myocardial content of energy-rich phosphates immediately after preservation and after 8 and 12 hours of ischemia at 5 degrees C; the remainder were reperfused after 8 and 12 hours of ischemia. Control variables during reperfusion were myocardial content of energy-rich phosphates, myocardial K+ uptake, left ventricular dP/dtmax and dP/dtmin, and incidence of arrhythmias in percentage of heart rate. RESULTS: Custodiol-preserved hearts contained more ATP than Celsior-preserved hearts after 8 and 12 hours of ischemia (8 hours p = ns, 12 hours, p < 0.05). During reperfusion after 8 hours of ischemia, dP/dtmax and dP/dtmin showed the same values for both solutions, after 12 hours values were significantly higher in Custodiol-preserved hearts (p < 0.005). The incidence of reperfusion arrhythmias was higher in hearts of the Celsior group (8 hours p < 0.01, 12 hours p = ns). Myocardial K+ uptake during reperfusion after 8 and 12 hours of ischemia was about twice as high in Celsior-preserved compared to Custodiol-preserved hearts (p < 0.005). CONCLUSIONS: In the Langendorff model of the canine heart, cardioplegia with Celsior showed no advantage over cardioplegia with Custodiol. Differences were observed, however, which may be clinically important, especially in the case of long cold-storage times.
