ABSTRACT: Postoperative coronary arterial spasm is a rare but potentially fatal complication. A 51-year-old male patient with a history of a reactive ergonovine stress test coronary angiogram developed refractory coronary artery spasm after undergoing minimally invasive direct coronary artery bypass grafting of the left anterior descending coronary artery. The patient was successfully managed with rapid implementation of intra-aortic balloon-pump counter pulsation and extracorporeal membrane oxygenation.
The Korean journal of thoracic and cardiovascular surgery. 08/2011; 44(4):288-91.
ABSTRACT: To assess the influence of bypass grafting technique on the flow characteristics and mid-term patency of saphenous vein coronary bypass grafts.
In the present study, 309 patients who underwent either sequential (group A, N = 84 grafts) or individual (group B, N = 244 grafts) saphenous vein coronary bypass grafting between February 2002 and September 2007 were investigated. Individual bypassing only was performed in 212 patients, and sequential bypassing only was performed in 78 patients. The remaining 19 patients received both. A total of 436 distal anastomoses were performed with 328 saphenous vein grafts. The intraoperative flow characteristics and the graft patency were assessed with the transit time flow meter and serial multi-detector computed tomography coronary angiograms, respectively.
Group A showed a higher mean flow compared with group B at 49.4 ± 27.4 mL/min versus 37.1 ± 20.1 mL/min, respectively (P = .001). The mean flow increased linearly as the number of anastomoses increased per graft (P < .001). Graft patency at 3 years was 93.3% ± 3.4% in group A and 86.5% ± 3.1% in group B (P = .048). After adjustment for baseline characteristics, group A showed a tendency for superior mid-term patency than group B (hazard ratio 0.362; 95% confidence interval, 0.129-1.017; P = .0538).
Sequential bypass grafts were associated with higher mean flows and superior mid-term patency compared with individual grafts. These findings suggest the more favorable results of sequential bypass grafting to be attributed to the enhanced flow hemodynamics.
The Journal of thoracic and cardiovascular surgery 03/2011; 141(3):750-4. · 3.41 Impact Factor
ABSTRACT: Although mitral valve (MV) repair is known to be superior to replacement in overall clinical outcomes, the appropriateness of valve repair for rheumatic MV disease remains controversial because of the risks of recurrent mitral dysfunction and the need for re-operation.
From 1997 to 2007, 540 patients underwent either isolated MV repair (n=122) or replacement with a mechanical prosthesis (n=418) in treatment of rheumatic MV disease. Survival and morbidity were evaluated using Kaplan-Meier analysis and Cox regression, including propensity score analysis.
Follow-up was complete in 96.1% of patients (mean, 71.8+/-39.1 months). Patients undergoing repair were younger; more likely to have predominant mitral regurgitation; and less likely to show atrial fibrillation (AF), significant tricuspid regurgitation or pulmonary hypertension, than those undergoing replacement. The 10-year freedom from cardiac death rate was 92.0+/-4.2% following repair and 86.8+/-2.3% following replacement (P=0.042). After adjustment for baseline differences, repair and replacement were found to be similar in terms of cardiac survival (P=0.25), re-operation (P=0.68) and thrombo-embolic complication (P=0.20) rates. Replacement patients had more anticoagulation therapy-related complications (P=0.030). Independent factors positively associated with combined cardiac death and major morbidities included older patient age (P=0.010), uncorrected AF (P=0.015) and the presence of significant tricuspid regurgitation (P=0.012) or coronary disease (P=0.043). The influence of the type of MV surgery was statistically marginal (P=0.093).
When performed for selected patients, MV repair had excellent durability comparable to mechanical valve replacement in rheumatic disease. Both MV repair and replacement had comparable long-term clinical results; therefore, repair surgery seems to be more beneficial by avoiding troublesome life-long anticoagulation and risks of bleeding.
European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery 05/2010; 37(5):1039-46. · 2.40 Impact Factor