Left main disease management strategy: indications and revascularization methods in particular groups of subjects.

Surgical revascularization with coronary artery by-pass grafting is still recommended in vast majority of patients with unprotected left main disease. The aim of the paper was to analyze optimal treatment of left main disease in selected groups of patients, on the basis of current guidelines and information gained from literature data. We focused on data in relation to treatment of elderly patients, diabetics and those hemodynamically unstable. Additionally we discussed the issue of anti-platelet therapy and informed consent. As far as efficacy of treatment is concerned, not only method of revascularization but also general condition of the patient, the factors influencing peri-operative risk and optimal pharmacotherapy should be taken into account. Therefore establishment of the heart team is crucial when choosing the most suitable method of invasive treatment of left main disease.

Preassembled stentless valved-conduit for the replacement of the ascending aorta and aortic root.

Here we report the early clinical results of a new preassembled stentless valved-conduit incorporating artificial sinuses of Valsalva (BioValsalva). This new composite conduit incorporates a stentless porcine aortic valve (Elan, Vascutek Terumo, UK) suspended within a triple-layered vascular conduit (Triplex, Vascutek Terumo, UK) constructed with sinuses of Valsalva. Between December 2006 and January 2008, 17 patients with the mean age of 65 years underwent aortic valve, root and ascending aorta replacement with the BioValsalva valved-conduit. There was no perioperative mortality. There were no myocardial infarctions, cardiac failure or cerebrovascular events. Mean cardiopulmonary bypass time was 156+/-56 min and ischemic time was 112+/-33 min. Eight patients required deep hypothermic circulatory arrest for additional distal ascending aorta replacement. Mean mediastinal drainage was 499+/-262 ml. Postoperative transthoracic echocardiography and CT-scans of the aorta in all patients before discharge demonstrated well-functioning prosthetic aortic valves with small residual mean gradients, no regurgitation, and the presence of sinuses of Valsalva. In conclusion, the novel prefabricated, composite stentless valved-conduit BioValsalva possesses excellent hemodynamic performance and can be implanted with low morbidity. In addition, the conduit material has good hemostatic properties which reduced bleeding, and is easy to implant with a variety of surgical techniques.

Replacement of the ascending aorta, aortic root, and valve with a novel stentless valved conduit.

PURPOSE: Biologic valved-conduit grafts avoid the need for anticoagulation and can exploit the excellent hemodynamic performance of stentless valves. Incorporation of sinuses of Valsalva into the neoaortic root can improve the function of the stentless valves. DESCRIPTION: Here we present a novel prefabricated stentless valved conduit incorporating sinuses of Valsalva and describe the technique of implantation. The BioValsalva (Vascutek Terumo, Renfrewshire, Scotland) valved conduit incorporates a stentless porcine aortic valve (Elan; Vascutek Terumo) suspended within a triple-layered vascular conduit (Triplex; Vascutek Terumo) constructed with sinuses of Valsalva. EVALUATION: The BioValsalva valved conduit was used in 12 patients with aortic regurgitation due to annuloaortic ectasia unsuitable for aortic valve repair and concomitant ascending aorta aneurysm, with no deaths and excellent functioned result. CONCLUSIONS: The prefabricated, composite, stentless valved conduit is composed of material that is hemostatic and reduces bleeding. It is easy to implant, with a short ischemic time, and lends itself well to a variety of insertion techniques.