Single center two years' experience of Ozaki procedure: Early follow-up.

The Ozaki Procedure is an innovative surgical technique aiming of aortic valve neocuspidization using glutaraldehyde-treated autologous pericardium was first developed by Ozaki et al in 2007. With this newly developed technique, valve replacement was achieved without using prosthetic material due to both aortic stenosis and aortic insufficiency. Between December 2020 and December 2022, a total of 59 patients were operated on with the Ozaki Procedure due to aortic valve pathologies in our center. We evaluated the pre- and postoperative as well as the first-month data of a total of 44 patients with isolated the Ozaki Procedure and compared their echocardiographic changes. Patients with isolated aortic valve pathology were included in the study. Fifteen patients who underwent simultaneous coronary artery bypass surgery and Ozaki Procedure were excluded from the analysis. In the first month after the operation, n:2 (%4.5) patients died. When the preoperative and postoperative 1st month echocardiographic data of the remaining patients were compared, it was found that the decrease in mean gradient, max gradient and peak velocity values in the aortic valve was statistically significant. This is due to the fact that reaching neo-valves has very similar hemodynamics to the native aortic valve. Aortic valve neocuspidization by Ozaki Procedure may be a viable alternative to both surgical aortic valve replacement (AVR) and transcatheter aortic valve implantation. Its popularity and application is increasing all over the world. Short and mid-term results are available in the literature. The short and mid-term results are good, and the long-term results are hopeful.

The effect of proximal anastomosis on the expansion rate of a dilated ascending aorta in coronary artery bypass surgery: a prospective study.

BACKGROUND: This study was designed to determine the short- and long-term effects of proximal aortic anastomosis, performed during isolated coronary artery bypass grafting (CABG) in patients with dilatation of the ascending aorta who did not require surgical intervention. METHODS: The study was performed on 192 (38 female and 160 male patients; mean age, 62.1 ± 9.2 years; range, 42-80 years) patients with dilatation of the ascending aorta who underwent CABG surgery between 1 June 2006 and 31 May 2014. In group 1 (n = 114), the saphenous vein and left internal mammarian artery grafts were used, and proximal anastomosis was performed on the ascending aorta. In group 2 (n = 78), left and right internal mammarian artery grafts were used, and proximal aortic anastomosis was not performed. Pre-operatively and in the first and third years postoperatively, the ascending aortic diameter was measured and recorded using transthoracic echocardiography at four different regions (annulus, sinus of Valsalva, sinotubular junction and tubular aorta). RESULTS: A statistically significant difference was found between the groups for the number of grafts used and the duration of aortic cross-clamping and cardiopulmonary bypass. No significant intergroup difference was seen for the mean diameter of the ascending aorta (p > 0.05). Annual changes in the aortic diameter were found to be extremely significantly different in both groups (p = 0.0001). Mean values of the aortic diameter at the level of the sinotubular junction and tubular ascending aorta, mean aortic diameters (p = 0.002 and p = 0.0001, respectively), annual increase in diameter (p = 0.0001 and p = 0.0001, respectively), and mean annual difference in diameter (p = 0.0001 and p = 0.0001, respectively) at one and three years postoperatively were statistically significantly different between the groups. CONCLUSION: In patients with ascending aortic dilatation who did not require surgical intervention and who had proximal anastomosis of the ascending aorta and underwent only CABG, we detected statistically significant increases in the diameter of the sinotubular junction and tubular aorta up to three years postoperatively.

On-pump beating-heart versus conventional coronary artery bypass grafting for revascularization in patients with severe left ventricular dysfunction: early outcomes.

BACKGROUND: We sought to evaluate the effects of on-pump beating-heart versus conventional coronary artery bypass grafting techniques requiring cardioplegic arrest in patients with coronary artery disease with left ventricular dysfunction. METHODS: We report the early outcomes associated with survival, morbidity and improvement of left ventricular function in patients with low ejection fraction who underwent coronary artery bypass grafting between August 2009 and June 2012. Patients were separated into 2 groups: group I underwent conventional coronary artery bypass grafting and group II underwent an on-pump beating-heart technique without cardioplegic arrest. RESULTS: In all, 131 patients underwent coronary artery bypass grafting: 66 in group I and 65 in group II. Left ventricular ejection fraction was 26.6% ± 3.5% in group I and 27.7% ± 4.7% in group II. Left ventricular end diastolic diameter was 65.6 ± 3.6 mm in group I and 64.1 ± 3.2 mm in group II. There was a significant reduction in mortality in the conventional and on-pump beating-heart groups (p < 0.001). Perioperative myocardial infarction and low cardiac output syndrome were higher in group I than group II (both p < 0.05). Improvement of left ventricular function after the surgical procedure was better in group II than group I. CONCLUSION: The on-pump beating-heart technique is the preferred method for myocardial revascularization in patients with left ventricular dysfunction. This technique may be an acceptable alternative to the conventional technique owing to lower postoperative mortality and morbidity.

CONTEXTE: Nous avons voulu comparer les effets du pontage coronarien sur coeur battant sous CEC (circulation extracorporelle) et ceux du pontage coronarien classique exigeant un arrêt cardioplégique chez des patients atteints de coronaropathie et de dysfonction ventriculaire gauche. MÉTHODES: Nous faisons état des premiers résultats aux plans de la survie, de la morbidité et de l'amélioration de la fonction ventriculaire gauche chez des patients qui avaient une fraction d'éjection faible et qui ont reçu un pontage coronarien entre août 2009 et juin 2012. Les patients ont été répartis en 2 groupes : le groupe I a été soumis à la technique de pontage coronarien classique et le groupe II a été soumis à la technique à coeur battant sous CEC sans arrêt cardioplégique. RÉSULTATS: En tout, 131 patients ont reçu un pontage coronarien : 66 dans le groupe I et 65 dans le groupe II. La fraction d'éjection ventriculaire gauche était de 26,6 % ± 3,5 % dans le groupe I et de 27,7 % ± 4,7 % dans le groupe II. Le diamètre télédiastolique ventriculaire gauche était de 65,6 ± 3,6 mm dans le groupe I et de 64,1 ± 3,2 mm dans le groupe II. On a noté une réduction significative de la mortalité dans les groupes soumis à l'intervention classique et à l'intervention à coeur battant sous CEC (p < 0,001). L'infarctus du myocarde peropératoire et le syndrome de faible débit cardiaque ont été plus fréquents dans le groupe I que dans le groupe II (tous deux p < 0,05). L'amélioration de la fonction ventriculaire gauche après l'intervention chirurgicale a été plus marquée dans le groupe II que dans le groupe I. CONCLUSION: La technique à coeur battant sous CEC est la méthode préférée de revascularisation myocardique chez les patients atteints d'une dysfonction ventriculaire gauche. Cette technique peut être une solution de rechange acceptable à la technique classique en raison des taux de mortalité et de morbidité postopératoires plus faibles qui y sont associés.

Posterior pericardiotomy reduces the incidence of atrial fibrillation, pericardial effusion, and length of stay in hospital after coronary artery bypasses surgery.

Artrial fibrillation is the most common arrhythmia that occurs after coronary bypass grafting operation with the rate of 30%. Atrial fibrillation is associated with hemodynamic instability, strokes, and prolonged hospital stay. Pericardial effusion is a risk factor for atrial fibrillation after cardiac surgery, and it occurs commonly in the posterior area during the post-operative period. The aim of this prospective study was to demonstrate the effectiveness of posterior pericardiotomy in reducing the incidence of atrial fibrillation. This prospective randomized study was carried out on 425 patients undergoing a coronary artery bypass grafting in our clinic between August 2009 and February 2011. There were 276 male patients and 149 female patients. These patients were randomly divided into two groups; posterior pericardial incision was performed in 213 patients (pericardiotomy group), while any pericardial incision was not performed in 212 patients (control group). Atrial fibrillation occurred more frequently in control group (62 patients, 14.6%), compared to the pericardiotomy group (14 patients, 3.1%; p < 0.0001). The incidences of early pericardial effusion, late pericardial effusion, and tamponade were also significantly higher in control group. Moreover, posterior pericardiotomy was associated with the decreases in the duration of stay in hospital and intensive care unit. In fact, the total hospital costs were lower in the pericardiotomy group. In conclusion, posterior pericardiotomy is an effective and safe technique that reduces early pericardial effusion, atrial fibrillation, length of stay in hospital, and hospital costs after the coronary artery bypasses grafting.