[show abstract][hide abstract] ABSTRACT: Purpose: To examine the relationship between incidence of later, local vascular events (restenosis and occlusion) and clinical factors including lipid levels after surgical or endovascular treatment of peripheral artery disease (PAD). Methods: Consecutive 418 PAD lesions (in 308 patients under the age of 70) treated with surgical (n = 188) or endovascular (n = 230) repair for iliac (n = 228) and infrainguinal (n = 190) lesions were retrospectively analyzed. Clinical features and lipid levels were compared between patients who developed vascular events (n = 51; VE group) and those who did not (n = 257; NoVE group). Results: Among assessed factors, post-therapeutic low-density lipoprotein cholesterol (LDL-C) levels (mg/dL) were significantly higher in the VE group (120.4 ± 31.2) than in the NoVE group (108.2 ± 25.1) (P = 0.01). Infrainguinal lesions were more common in the VE than in the NoVE group (P <0.001). Cox hazard analysis indicated that infrainguinal lesions relative to iliac lesions significantly increased the risk of vascular events (hazard ratio (HR) 3.35; 95% CI 1.63-6.90; P = 0.001) and post-therapeutic LDL-C levels <130 (mg/dL) decreased the risk (HR 0.34; 95%CI 0.17-0.67; P = 0.002). Conclusion: Lowered post-therapeutic LDL-C levels can decrease the risk of later, local vascular events after PAD treatment. These results may support the rationale for aggressive lipid-modifying therapy for PAD.
[show abstract][hide abstract] ABSTRACT: Purpose: To examine the relationship between the incidence of later cardiovascular events after abdominal aortic aneurysm (AAA) surgery and postoperative lipid levels. Methods: Atherosclerotic risk factors including postoperative serum lipid levels were examined in 116 patients aged 70 or less undergoing an elective AAA surgery. Later cardiovascular events after AAA surgery occurred in 21 patients, including cerebral infarction (n = 4), catheter intervention or surgery for coronary artery disease (CAD) (n = 10) and other vascular disease. Results: Postoperative cholesterol levels during the average follow-up period of 55.6 ± 44.3 (months) were 49.0 ± 15.7 (mg/dL) for high-density lipoprotein cholesterol (HDL-C), 97.9 ± 31.2 (mg/dL) for low-density lipoprotein cholesterol (LDL-C), which were both significantly improved compared to preoperative values (p <0.001). Cox hazard analysis indicated that preexistent CAD significantly increased in the risk for later cardiovascular events (hazard ratio 5.67; 95%CI 1.92-16.8; p = 0.002) and lowered postoperative LDL-C/HDL-C ratio <1.5 decreased in the risk after AAA surgery (hazard ratio 0.10; 95%CI 0.01-0.83; p = 0.033). Patients with postoperative LDL-C/HDL-C ratio <1.5 (n = 22) had a significantly better cardiovascular event-free rate than those with that ratio ≥1.5 (n = 94) (p = 0.014). Conclusion: Lowered postoperative LDL-C/HDL-C ratio <1.5 can decrease in the risk for later cardiovascular events after AAA surgery. These results may support the rationale for postoperative aggressive lipid-modifying therapy.
[show abstract][hide abstract] ABSTRACT: Purpose: To determine the predictive value of serum lipid levels on the development of later cardiovascular events after abdominal aortic aneurysm (AAA) surgery. Methods: A total of 101 patients under 70 undergoing an elective AAA surgery were divided into the following two groups: 1) those who developed later cardiovascular events after AAA surgery, including cerebral infarction (n = 4), catheter intervention (PCI) or surgery for coronary artery disease (CAD) (n = 9) and other vascular disease. (CVE group; n = 19); 2) those without later events (NoCVE group: n = 82). Preoperative atherosclerotic risk factors including serum lipid levels were subjected to univariate and multivariate analysis. Results: The CVE group showed a significantly lower high-density lipoprotein cholesterol (HDL-C) level (32.9 ± 6.6 vs 41.6 ± 12.1 mg/dL; p <0.001), higher low-density lipoprotein cholesterol (LDL-C) / HDL-C ratio (4.30 ± 1.01 vs 3.24 ± 1.15; p = 0.001), and higher prevalence of mild CAD (without an indication of PCI) (p = 0.029) preoperatively. Cox hazard analysis indicated that preexistent mild CAD (hazard ratio 4.70) and preoperative HDL-C <35 mg/dL (hazard ratio 3.07) were significant predictors for later cardiovascular events after AAA surgery. Conclusion: Patients at high risk for later cardiovascular events should require a careful follow-up and may also require an aggressive lipid-modifying therapy.
[show abstract][hide abstract] ABSTRACT: To identify the most prognostic predictor of Stanford type B aortic dissection at admission.
Forty-three patients with Stanford type B aortic dissection were divided into two groups: (1) those who developed dissection-related events later (EV group: n = 18), including the need for surgery (n = 12), rupture (n = 1), dissection-related death (n = 5), and aortic enlargement > or =5 mm in diameter per year (n = 15); (2) those without later events (NoEV group: n = 25). Clinical features, aortic diameters, and blood flow status were compared.
The maximum aortic diameter at admission was 41.5 +/- 1.7 mm for the EV group, which was significantly greater than the NoEV group (34.4 +/- 0.9 mm, p <0.001). A maximum aortic diameter > or =40 mm was found in 11 patients (61%) of the EV group, whereas this maximum was found in 4 (16%) of the NoEV group (p = 0.004). A patent false lumen at admission was found in all patients of the EV group and in 17 (68%) of the NoEV group (p = 0.013). Other factors were not significant. A Cox hazard analysis indicated a maximum aortic diameter > or =40 mm as a significant predictor for dissection-related events (hazard ratio 3.13, p = 0.032). The presence of a patent false lumen did not reach a statistical significance.
Our results indicated that a maximum aortic diameter > or =40 mm at admission was the most prognostic factor for developing late dissection-related events, rather than the presence of a patent false lumen.
Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia. 10/2008; 14(5):303-10.
[show abstract][hide abstract] ABSTRACT: We report a case of hypertrophic obstructive cardiomyopathy (HOCM) successfully treated with septal myectomy and mitral valve replacement (MVR) combined with a resection of the hypertrophic papillary muscles. The patient, a 74-year-old woman, first underwent the conventional septal myectomy through aortotomy. The papillary muscles revealed a marked hypertrophy, but extended myectomy and precise resection of the hypertrophic papillary muscles were thought to be difficult through the aortotomy. Through the right-sided left atriotomy, MVR and resection of the papillary muscles were additionally performed. The patient was smoothly weaned from the cardiopulmonary bypass, and the postoperative course was uneventful. The outflow pressure gradient was relieved to 0 mm Hg, from 94. The mean pulmonary artery pressure was reduced to 27 mm Hg, from 42. The patient has been doing well in the New York Heart Association (NYHA) functional class between I and II during 45 months of follow-up, without complications related to the use of a prosthetic valve. Septal myectomy is the procedure of choice in the surgical treatment of HOCM for most cases, but some may require additional mitral valve procedures. In patients with marked hypertrophic papillary muscles, MVR and resection of the muscles may be an option of treatment to ensure a relief of the outflow obstruction and to abolish systolic anterior movement in units with limited experience.
Annals of thoracic and cardiovascular surgery: official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia 09/2008; 14(4):258-62. · 0.47 Impact Factor