[Show abstract][Hide abstract] ABSTRACT: To compare intraoperative and postoperative transfusion requirements in patients undergoing aortic valve replacement by mini-sternotomy in “J” vs conventional sternotomy.
No preview · Article · May 2015 · Cirugia Cardiovascular
[Show abstract][Hide abstract] ABSTRACT: Objectives: Mitral valve neochordal repair may be a complex procedure in cases of large areas of prolapse. We describe the
use of a novel technique in different anatomical situations.
Methods: A new technique for extensive neochordal repair was used in 4 patients with different types of prolapse: posterior,
anterior, commissural and bileaflet prolapse. The neochordae were attached to the corresponding papillary muscle with a single
stitch and then were implanted on the leaflet weaving the artificial chordae along the surface of coaptation. Free-edge leaflet
remodelling was achieved to obtain a wide surface of coaptation. Neochordal length was determined after folding the prolapsing
leaflet towards the annulus. The annular plane was considered as the main reference to adjust the height of the artificial
Results: Neochordal repair was successfully performed in all these types of prolapse. Implantation of multiple neochordae
was necessary. This procedure was capable of creating a large surface of coaptation in cases of complex commissural repair
or large areas of prolapse on both leaflets, particularly in severe Barlow disease. Postoperative transoesophageal echocardiography
(TEE) revealed adequate mitral leaflet coaptation, trivial residual mitral regurgitation (MR) and absence of systolic anterior
Conclusion: This procedure might facilitate the use of extensive neochordal repair in complex cases of prolapse on both leaflets.
A variety of affected areas was considered to evaluate this technique with excellent functional results.
Full-text · Article · Oct 2014 · Interactive Cardiovascular and Thoracic Surgery
[Show abstract][Hide abstract] ABSTRACT: Aims:
In the present study we investigated the intervention of nitric oxide and prostacyclin in the responses to vasopressin of isolated thyroid arteries obtained from multi-organ donors.
Paired artery rings from glandular branches of the superior thyroid artery, one normal and the other deendothelised, were mounted in organ baths for isometric recording of tension. Concentration-response curves to vasopressin were determined in the absence and in the presence of either the vasopressin V1 receptor antagonist d(CH2)5Tyr(Me)AVP (10(-8)M), the nitric oxide synthase inhibitor N(G)-monomethyl-l-arginine (L-NMMA, 10(-4)M), or the inhibitor of prostaglandins indomethacin (10(-6)M).
In artery rings under resting tension, vasopressin produced concentration-dependent, endothelium-independent contractions. The vasopressin V1 receptor antagonist d(CH2)5Tyr(Me)AVP (10(-8)M) displaced the control curve to vasopressin 19-fold to the right in a parallel manner. The contractile response to vasopressin was unaffected by L-NMMA or by indomethacin.
Vasopressin causes constriction of human thyroid arteries by stimulation of V1 vasopressin receptors located on smooth muscle cells. These effects are not linked to the presence of an intact endothelium or to the release of nitric oxide or prostaglandins. The constriction of thyroid arteries may be particularly relevant in certain pathophysiological circumstances in which vasopressin is released in amounts that could interfere with the blood supply to the thyroid gland.
[Show abstract][Hide abstract] ABSTRACT: Functional mitral regurgitation often is associated with dilated cardiomyopathy, or left ventricular remodeling. Surgical repair result commonly in an annuloplasty ring. We present a case of severe mitral regurgitation due to dilated cardiomyopathy treated with implant of Geoform® annuloplasty ring, with a good immediate outcome, and a successive failure of the annuloplasty due to dehiscence of the ring and requirement of a mitral valve replacement.
No preview · Article · Jul 2013 · Cirugia Cardiovascular
[Show abstract][Hide abstract] ABSTRACT: Background
The use of neochordal repair has recently increased, not only as a combined procedure with quadrangular resection, but also as an isolated technique. Our aim was to evaluate its impact on the feasibility and outcomes of mitral valve repair.
Material and methods
A global group of 203 patients underwent valve repair for degenerative mitral regurgitation between 1997-2011. Their mean age was 62 ± 12 years and 36% were females. Complex repair was considered in case of multi-scalloped, bileaflet or commissural prolapse. Two technical subgroups were compared: resection without neochordal repair (Group-A: 140 patients) and neochordal repair without resection (Group-B: 46 patients). Seventeen patients with artificial chordae combined with resection were excluded. Complexity of valvular lesions, early and long-term mortality and repair durability were studied.
In-hospital mortality was 3.4% (7 patients); 4.3% in Group-A (6 patients) and 2.2% in Group-B (one patient). Five and 10-year survival was 89 ± 2% and 77 ± 4%. At follow-up (58 ± 42 months), 22 patients from Group-A (15.7%) and 2 from Group-B (4.3%) died. The recurrence of grade 3-4/4 mitral regurgitation in Group-B versus Group-A was 1 (2.2%) versus 20 (14.3%); P < .05. Sixty five patients (32.0%) underwent complex repairs, especially from Group-B: 27 (58.7%) vs 27 (19.3%), P < .0001. This group had a higher incidence of multi-scalloped prolapse (mean number of segments): 1.80 ± 0.80 vs 1.20 ± 0.44, P < .0001; anterior leaflet prolapse: 14 (30.4%) vs 14 (10.0%), P < .01, and multiple chordal rupture: 24 (52.2%) vs 29 (20.7%), P < .0001.
Neochordal repair showed excellent mid-term results with significant increase of repair feasibility. Its use as an isolated procedure has been really effective in patients with more extensive and complex lesions
No preview · Article · Jul 2013 · Cirugia Cardiovascular
[Show abstract][Hide abstract] ABSTRACT: Introduction and objectives:
The aim of this study was to compare the in-hospital clinical outcomes of minimally invasive, isolated aortic valve replacement vs median sternotomy.
Between 2005 and 2012, 615 patients underwent aortic valve replacement at a single institution, 532 by a median sternotomy (E group) and 83 by a J-shaped ministernotomy (M group).
No significant differences were found between the E and M groups in terms of age (69.27 [9.31] years vs 69.40 [10.24] years, respectively), logistic EuroSCORE (6.27 [2.91] vs 5.64 [2.17], respectively), size of implanted valve prosthesis (21.94 [2.04] mm vs 21.79 [2.01] mm, respectively), or the incidence of diabetes, hypercholesterolemia, high blood pressure, or chronic obstructive pulmonary disease. Mean cardiopulmonary bypass time was 102.90 (41.68) min for the E group vs 81.37 (25.41) min for the M group (P<.001). Mean cross-clamp time was 77.31 (29.20) min vs 63.45 (17.71) min for the S and M groups, respectively (P<.001). Mortality in the E group was 4.88% (26). There were no deaths in the M group (P<.05). The E group was associated with longer intensive care unit and hospital stays: 4.17 (5.23) days vs 3.22 (2.01) days (P=.045) and 9.58 (7.66) days vs 7.27 (3.83) days (P<.001), respectively. E group patients had more postoperative respiratory complications (42 [8%] vs 1 [1.2%]; P<.05). There were no differences when postoperative hemodynamic, neurologic, and renal complications, systemic infection, and wound infection were analyzed.
In terms of morbidity, mortality, and operative times, outcomes after minimally invasive surgery for aortic valve replacement are at least comparable to those achieved with median sternotomy. The length of the hospital stay was reduced by minimally invasive surgery in our single-institution experience. The retrospective nature of this study warrants further randomized prospective trials to validate our results.
No preview · Article · Jun 2013 · Revista Espa de Cardiologia
[Show abstract][Hide abstract] ABSTRACT: Background
Etiology and other factors may influence the outcomes of mitral valve repair. We have analyzed survival and durability in a variety of etiologies.
Material and Methods
406 patients underwent mitral valve repair (1997–2011) with ages between 19–84 years. 156 were females (38.4%). 57.1% patients were in NYHA class III-IV. 5 groups were considered: degenerative (group-D), 203; ischemic (group-I), 90; functional (non-ischemic) (group-F), 19; rheumatic (group-R), 61 and endocarditis (group-E), 33 patients. Undersized annuloplasty was used in ischemic and functional groups. Quadrangular resection and neochordal repair were predominant in case of degenerative etiology whereas a variety of resective and reconstructive techniques were used in rheumatic and endocarditis groups.
30-day mortality was 4.4%: 3.4%, 4.4%, 0%, 6.6% and 10% in respective groups. 5 and 10-year survival: 86 ± 1% and 70 ± 4%. Long-term mortality was higher in groups F and I (31.6% and 20%) compared with 12.3%, 11.5% and 13.3% in groups D, R and E. Group-D had higher durability and freedom from grade 3–4/4 mitral regurgitation than non-degenerative groups: 86 ± 2 vs 84 ± 2% (p = 0.46) at 5 years and 82 ± 3 vs 54 ± 1% (p = 0.02) at later follow-up. Group-R was associated with recurrent grade-3 and grade-4 mitral regurgitation (OR: 1.98, 95%-CI: 1.01–3.89; p = 0.05 and OR: 3.31, 95%-CI: 1.17–9.32; p = 0.02). 14 patients underwent mitral valve replacement: 3, 1, 1, 6 and 3.
The outcomes of mitral valve repair were successful. Survival, recurrence rate and reoperation were excellent in group-D. Rheumatic regurgitation had shorter durability and functional mitral regurgitation had lower survival.
No preview · Article · Apr 2013 · Cirugia Cardiovascular
[Show abstract][Hide abstract] ABSTRACT: Objectives:
Increasing degrees of renal impairment are associated with higher rates of morbimortality after coronary artery bypass grafting (CABG). This incremental risk has not been well studied in off-pump procedures (OPCAB). We assessed its impact on OPCAB and on-pump CABG (ONCAB).
A total of 1769 patients undergoing primary CABG (January 1995 through June 2011) had complete data on glomerular filtration rate (eGFR). 930 patients had Stage 2 renal insufficiency, 330 Stage 3, 27 Stage 4 and 465 normal renal function (Stage 1). Seventeen patients with end-stage disease (Stage 5) were excluded. The OPCAB technique was selectively used in 350 high-risk patients. Preoperative variables and postoperative outcomes were compared among eGFR subgroups and between matched and unmatched OPCAB vs ONCAB groups.
Stages 3-4 patients were older (P < 0.0001), with higher prevalence of diabetes (36.8, 35.0, 39.7 and 74.1%, P < 0.01, 1-4 eGFR groups) peripheral arteriopathy (6.0, 9.0, 15.8 and 29.6%, P < 0.0001) and lower left ventricular ejection fraction (LVEF) (GFR-LVEF correlation: Pearson: 0.12, P < 0.0001). On-pump GFR groups had increasingly higher in-hospital mortality (1.0, 1.2, 3.5 and 15.4%, P < 0.0001), but no differences were observed in OPCAB (5.5, 4.8, 5.4 and 7.1%, P = 0.97). Similar trends on in-hospital morbidity were observed in ONCAB vs OPCAB groups: low cardiac output (P < 0.01), pneumonia (P < 0.01) and stroke (P < 0.05). GFR only predicted mortality in ONCAB patients (odds ratio (OR): 0.96, 95% CI: 0.94-0.98; P < 0.01). Patients with higher eGFR stages had statistically more reduced long-term survival, and this pattern was similar in the three treatment groups, also including the OPCAB group, who had the lowest survival in patients with eGFR stage 4.
Patients with low GFR (Stages 3-4) undergoing ONCAB were at increased risk of early morbimortality. In contrast, there were no significant differences in operative morbimortality among eGFR groups in OPCAB patients. This 'off-pump advantage' on early outcomes was not observed at the long-term follow-up.
No preview · Article · Feb 2013 · European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery