A High Prevalence of Intracranial Stenosis in Patients with Coronary Artery Disease and the Diagnostic Value of Transcranial Duplex Sonography.

BACKGROUND: According to the data from the population-based Rotterdam study, intracranial carotid artery calcification detected by computed tomography is very common and contributed to 75% of all strokes. The aim of the present study was to estimate the prevalence of intracranial stenosis (IS) using noninvasive transcranial color-coded duplex sonography (TCCS) in neurologically asymptomatic patients with coronary artery disease (CAD). METHODS: Three hundred and eighty-nine patients with angiographically-confirmed, severe CAD were included prospectively. All of them were examined using extracranial and TCCS. RESULTS: Out of 389 patients (age 66.7 ± 9.2, 39-88), 237 (61%) were diagnosed with 3 vessels disease and 152 patients (39%) with left stem disease with/without 3 vessels damage. Transcranial sonography revealed at least 1 IS in 63.6% of echo positive patients (220/346). IS was found in 127 (61.4%) patients with 3 vessels disease, 20 patients (58.8%) with isolated left stem disease, and 73 patients (69.5%) with 3 vessels and left stem disease (P = .305). In the case of significant (≥50%) extracranial internal carotid artery stenosis, intracranial stenosis were detected in 84.8% (50 of 59), in the case of mild (<50%) stenosis, in 59.2% (170 of 287), P < .001. CONCLUSIONS: It was found that two thirds of patients with advanced CAD have a silent IS. TCCS is a reliable method for the evaluation of intracranial atherosclerosis in such patients in order to gain useful information about cerebrovascular disease as a risk factor for stroke.

Efficacy of Aortic Valve Replacement through Full Sternotomy and Minimal Invasion (Ministernotomy).

Background: new minimally invasive sternotomy (mini-sternotomy) procedures have improved the treatment outcome and reduced the incidence of perioperative complications leading to improved patient satisfaction and a reduced cost of aortic valve replacement in comparison to the conventional median sternotomy (full sternotomy). The aim of this study is to compare and gain new insights into operative and early postoperative outcomes, long-term postoperative results, and 5-year survival rates after aortic valve replacement through a ministernotomy and full sternotomy. Methods: This is a retrospective study of patients who underwent an isolated replacement of the aortic valve via a full sternotomy or ministernotomy from 2011 to 2016. From 2011 to 2016, 426 cardiac interventions were performed, 70 of which (16.4%) were of the ministernotomy and 356 (83.6%) of the full sternotomy. Through propensity score matching, 70 patients who underwent the ministernotomy (ministernotomy group) were compared with 70 patients who underwent the full sternotomy (control group). Results: in the propensity matching cohort, no statistical difference in operative time was noted (p = 0.856). The ministernotomy had longer cross clamp (88.7 ± 20.7 vs. 80.3 ± 24.6 min, p = 0.007) and bypass (144.0 ± 29.9 vs. 132.9 ± 44.9 min, p = 0.049) times, less ventilation time (9.7 ± 1.7 vs. 11.7 ± 1.4 h, p < 0.001), shorter hospital stay (18.3 ± 1.9 vs. 21.9 ± 1.9 days, p = 0.012), less 24-h chest tube drainage (256.2 ± 28.6 vs. 407.3 ± 40.37 mL, p < 0.001), fewer corrections of coagulopathy (p < 0.001), fewer patients receiving catecholamine (5.71 vs. 30.0%, p < 0.001) and better cosmetic results (p < 0.001). Moreover, the number of patients without complaints at 1 year after the operation was significantly greater in the ministernotomy group (p = 0.002), and no significant differences in the 5-year survival between the groups were observed. In the overall cohort, the ministernotomy had longer cross clamp times (88.7 ± 20.7 vs. 79.9 ± 24.8 min, p < 0.001), longer operative times (263.5 ± 62.0 vs. 246.7 ± 74.2 min, p = 0.037) and bypass times (144.0 ± 29.9 vs. 132.7 ± 44.5 min, p = 0.026), lower incidence of 30-day mortality (1(1.4) vs. 13(3.7), p = 0.022), shorter hospital stays post-surgery p = 0.025, less 24-h chest tube drainage, p < 0.001, and fewer corrections of coagulopathy (p < 0.001). Conclusions: the ministernotomy has a number of advantages compared with the full sternotomy and thus could be a better approach for aortic valve replacement.

[Late outcomes of on-pump and off-pump redo coronary artery bypass grafting]. / Pakartotiniu aortos vainikiniu arteriju jungciu suformavimo operaciju su (be) dirbtine kraujo apytaka velyvieji pooperaciniai rezultatai.

UNLABELLED: Benefits of off-pump surgery are still widely debated in the literature comparing with conventional coronary artery bypass grafting. The aim of our study was to compare the late outcomes of patients who underwent on-pump redo coronary artery bypass surgery with those who had off-pump redo coronary artery bypass surgery. MATERIAL AND METHODS: Two groups of patients were compared. Group 1 consisted of 34 patients who underwent off-pump redo coronary artery bypass surgery, and Group 2 included 160 patients who underwent on-pump redo coronary artery bypass surgery. Both groups of patients were operated on by the same team of surgeons at the same time period. Groups did not differ by age, gender, functional class, preoperative myocardial infarction rate, and left ventricular function. More patients with hypertension were in the off-pump group. Significantly more grafts were performed in the on-pump group. Survival, presence of angina, reoccurrence of postoperative myocardial infarction, necessity of percutaneous transluminal coronary angioplasty and reoperations were evaluated in late follow-up period. The duration of follow-up was 3.37+/-2.15 years in the off-pump group and 3.27+/-2.36 years in the on-pump group. RESULTS: Survival after 6 years in the off-pump and on-pump redo coronary artery bypass surgery groups was 85.3% and 83.6%, respectively (P=0.758). Five years after redo operation, 54.9% of patients who underwent off-pump coronary artery bypass surgery and 69.3% of patients who underwent on-pump coronary artery bypass surgery had no angina (P=0.174). There were no major cardiac events (percutaneous transluminal coronary angioplasty, death, myocardial infarction, and reoperations) after 6 years in 69.7% of patients in the off-pump group and 76.9% of patients in the on-pump group (P=0.343). Five years after redo surgery, 79.4% of patients in the off-pump group and 91.9% in the on-pump group were free of percutaneous transluminal coronary angioplasty (P<0.02). CONCLUSIONS: There was no difference in survival despite the fact that patients in the on-pump group received more grafts than those in the off-pump group. Recurrence of angina and incidence of major cardiac events were almost equal in both the groups. Percutaneous transluminal coronary angioplasty was more frequently performed in the patients of off-pump group at late follow-up.

[Extra-anatomic thoracic aortic bypass operations]. / Krutines aortos apeinamuju jungciu suformavimo operacijos.

OBJECTIVE: When the patient condition contraindicates major surgery for descending thoracic aneurysms, the surgeon should consider using an ascending aorta to abdominal aorta bypass graft, leaving the diseased segment undisturbed. Our experience with eight patients is presented. MATERIAL AND METHODS: Between 1988 and 2008, eight patients were treated for the following indications: reoperation for coarctation (two patients), complicated descending aortic aneurysms (five patients), and posttraumatic descending aorta dissection (one patient). The mean age of the patients was 44+/-8 years (range, 27-53 years). There were 6 (75%) males and 2 (25%) females. Emergency operations were performed in three patients (two with aortic recoarctation, one with posttraumatic aortic dissection). Two cases were reoperations (both after recoarctation). Descending aorta was ligated in seven cases. Distal anastomosis was connected with abdominal aorta in four cases and with iliac arteries in four patients. RESULTS: Three early deaths occurred. Two patients died after emergency operation after recoarctation and posttraumatic aortic dissection, and one patient died after descending aorta aneurysm correction because of bleeding. CONCLUSIONS: In complex aortic coarctation, extra-anatomic bypass operation remains an effective procedure. The usage of these procedures in patients with descending aortic aneurysms remains complicated.

[Total and partial arterial revascularization]. / Visiska ir daline arterine revaskulizacija.

UNLABELLED: It was shown in a long-term studies that internal thoracic arteries have higher patency, rate compared with saphenous veins grafts. The study was designed to evaluate the late results (1-4 years) of arterial (internal thoracic arteries and radial artery) and venous grafts in a patients referred to coronary revascularization. From April 1997 to June 2002, 405 patients were operated upon using radial artery and internal thoracic arteries and saphenous veins grafts in Vilnius University Heart surgery clinic and Heart Surgery center. One hundred twenty two patients were controlled at 3-36 months. 93% of patients were in CCS f. cl. 0 or 1. Twenty seven symptomatic patients were investigated angiografically at 17,6+/-10 months, and was found patent internal thoracic arteries - 93%, radial artery - 79% and saphenous veins grafts - 62%. CONCLUSION: Arterial grafts tends to be superior than veins grafts in the midterm period.

[Coronary reoperations]. / Pakartotine miokardo revaskulizacija.

BACKGROUND: We report our experience with 85 patients undergoing a second time CABG in our institution, highlighting surgical techniques and results. METHODS: Eighty five patients underwent a second coronary artery revascularization between 1971 and 2002 at Vilnius University Hospital Santariskiu Clinics. There were 78 men (91.8%); the mean age was 56.5 years (range 40-75). The reason for the second operation was graft failure in 89.4% of the cases. RESULTS: Direct myocardial revascularization was performed in all patient with a mean of 2.4 graft per patient (range 1-4). The internal mammary artery was utilized 17.6%. Hospital mortality was 1.1%. CONCLUSION: Our data suggest that a second - time coronary revascularization can be justified, with gratifying operative success and good results.

[Coronary artery revascularization without cardiopulmonary bypass]. / Vainikiniu arteriju revaskulizacija nenaudojant dirbtines kraujo apytakos.

OBJECTIVE: We sought to report our recent experience with off-pump coronary artery revascularization. MATERIAL AND METHODS: Between July 1998 and July 2002, 80 off-pump beating heart operations were performed at Vilnius University Hospital Heart Surgery Clinic, representing 4.05% of all coronary artery revascularization. This cohort of patients was compared with 241 patients operated on with cardiopulmonary by pass. RESULTS: Mean age and preoperative risk factors were comparable for the two groups. On average, 2.02+/-0.86 and 4.09+/-1.09 grafts per patient were completed in the beating and cardiopulmonary bypass groups, respectively. Operation time was shorter in the beating heart group (169+/-41 vs. 215+/-59 minutes). Similarly, the need for transfusion was significantly smaller in the beating heart group (beating heart operations, 10%; cardiopulmonary bypass, 28%; p<0.001). CONCLUSIONS: In majority of patients, off-pump coronary artery revascularization is an acceptable alternative to conventional operations with good results.