Biomedical subjects

Giedrius Uzdavinys

Publications and source records attributed to Giedrius Uzdavinys.

10 recordsLinked to original sources

PubMed2004

[Radiofrequency modified maze procedure with mitral valve surgery: mid-term follow-up results].

OBJECTIVE: The Cox-maze procedure is an effective established surgical method for elimination of atrial fibrillation. The aim of this study was to evaluate the efficacy and safety of radiofrequency ablation as a surgical adjunct in treating atrial fibrillation and to adapt maze principles to mitral valve surgery using transseptal approaches. MATERIAL AND METHODS: Thirty-six patients underwent radiofrequency modified maze procedure using standard and cooled ablation electrodes in combination with surgery for hemodynamically significant mitral valve disease and chronic, persistent or paroxysmal atrial fibrillation. Fourteen (39%) patients had mitral valve repair and 22 (61%) patients had mitral valve replacement; 33 (91.6%) patients underwent concomitant surgical procedures. RESULTS: The cardiopulmonary bypass time was 162+/-38 min, the aortic cross-clamp time - 98+/-22 min. The additional aortic cross-clamp time required for the radiofrequency modified maze procedure was 21+/-3 min. Postoperative mortality was 2.8%. In 7 of 36 pts (19.4% ) significant bradycardia requiring permanent pacing (six - AAI, one - DDD) was seen after the operation. Patients were followed up for 4 months to 2.5 years after surgery (mean 11.2+/-7.4 months). There were no deaths, no thromboembolic complications during follow-up. Freedom from atrial fibrillation or flutter was 100% at the end of operation, but during 0.5-3 months after operation atrial fibrillation or flutter were observed in 41.6% (15/36) patients. In 2 (5%) patients chronic atrial fibrillation developed. Freedom from atrial fibrillation/flutter was 86% (12/14) at 1 year postoperatively. CONCLUSIONS: The radiofrequency modified maze as an adjunctive procedure is safe and effective in eliminating atrial fibrillation using standard and cooling-tip ablation electrodes in combination with surgery for mitral valve disease.

Aged↗

PubMed2004

[Disorders of neurocognitive function after coronary artery bypass grafting].

OBJECTIVE: Neurocognitive dysfunction still remains a frequent problem after heart surgery, complicating early recovery and strongly affecting postoperative quality of life. The aim of our study was to determine incidence of cognitive dysfunction after coronary artery bypass grafting for patients of low risk group and to find operative and postoperative factors associated with early cognitive impairment. MATERIAL AND METHODS: Using exclusion criteria, which are known as risk factors for postoperative neurological complications we selected a group of 30 coronary artery bypass grafting patients. The day before surgery and 7 to 8 days after operation we evaluated cognitive function of each patient using MMSE and standardized test battery of five neuropsychological tests. The incidence of cognitive decline was evaluated using composite z scores and 1 SD criteria. Preoperative ultrasound screening of asymptomatic carotid artery was performed for each patient. RESULTS: Early postoperative cognitive dysfunction was present in 13 (46.3%) of patients. Patients with cognitive decline more often had asymptomic, hemodynamicly significant carotid artery stenosis. Duration of operation and coronary artery bypass time was longer in cognitive dysfunction group. As well there were more grafts performed to this group of patients. We noticed a relationship between lower temperature during coronary artery bypass and cognitive impairment. CONCLUSIONS: Incidence of cognitive dysfunction for patients of low risk group was 46.3%. Cognitive decline was associated with prolonged coronary artery bypass, operation time and number of grafts.

Age Factors↗

PubMed2002

[Follow-up results after left ventricular geometry and volume restoration operations in patients with postinfarctic aneurysm].

UNLABELLED: Fifty patients underwent surgery due to reconstruction of the left ventricular volume and geometry together with heart revascularisation since 1999.02 till 2002.05 of Clinic of Heart Surgery, Vilnius University and Vilnius Heart Surgery Center. Forty eight patients were evaluated in late postoperative period at 3-44 months after the surgery. The functional status of patients improved and the mean NYHA functional class went down from 3.75 till 2.31 (p<0.01). The mean left ventricular ejection fraction significantly raises after operation from 31.8 to 37.8%. Twelve patients in late postoperative period had symptoms of congestive heart failure. These patients had a large asynergy and most intraventricular conductivity disturbances preoperatively. The left ventricular ejection fraction after operation for these patients had no changes and compared with good filling patients they still had larger asynergy. CONCLUSIONS: 1. The functional status of most patients improved after the operation. 2. The left ventricular ejection fraction became better after operation. 3. The stability of good results after 3 years was 65%. 4. Long- term survival after 3 years was 89%.

Adult↗

PubMed2002

[Total and partial arterial revascularization].

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.

Aged↗

PubMed2002

[Coronary reoperations].

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.

Adult↗

PubMed2002

[Coronary artery revascularization without cardiopulmonary bypass].

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.

Aged↗

PubMed2002

[Myocardial revascularization combined with mitral valve surgery in case of ischemic mitral valve insufficiency].

BACKGROUND: The aim of the study was to evaluate the possibility of mitral valve surgery in patients with mitral valve insufficiency and short time outcomes following mitral valve correction combined with coronary artery bypass grafting. METHODS: Thirty one combined coronary artery bypass grafting with mitral valve correction procedures were performed from 1994 to 2002. Mean age was 65.4+/-6 years. 29 pts were in NYHA IV-V functional class. 84% of pts were with impaired left ventricle function. RESULTS: Mitral valve replacement was performed in 16 patients and correction of mitral valve in 15 cases. Mitral valve replacement was performed in cases with significant lesions of the papillary muscles. The mean of 3.05+/-1.8 graft per patient was performed and total coronary revascularisation for 84% of patients. Hospital mortality was 32.2% (10/31). CONCLUSION: In cases of coronary artery bypass grafting for patients with moderate and significant mitral insufficiency after myocardial infarction, mitral valve correction must be performed.

Aged↗

PubMed2002

[Coronary artery bypass procedures in the elderly. Risk factors and outcome].

BACKGROUND: an increasing number of elderly patients are being accepted for cardiac surgery. METHODS: Ninety seven consecutive patients older than 75 years, undergoing CABG procedures, were studied to assess short-term survival. They were compared with 975 younger patients undergoing similar procedure during the same time interval. RESULTS: Hospital mortality was increased (12.3% versus 1.3%) in elderly patients. Postoperative complications were also more common in older patients than in patients younger than 75 years. CONCLUSIONS: Coronary artery bypass grafting can be performed in elderly patients with acceptable risk.

Adult↗

PubMed2002

[The intraaortic balloon pumping--old problems and innovation].

UNLABELLED: Method of this treatment in Vilnius University Heart Surgery Clinic was started in 1976. The intraaortic balloon pumping in the urgent primary mechanical circulator support device for postcardiotomic heart failure. Method of this treatment was started in 1976. Demand of intraaortic balloon pumping was for 744 postcardiothomic patients (5.4%). The heart pathology that required postcardiotomic intraaortic balloon pumping were: heart valve replacement or repair - 385, coronary artery bypass grafting - 316, complex heart operations - 34, after heart transplant - 6, coronary artery bypass grafting plus left ventricle remodelation - 3. Four methods of intraaortic balloon insertion were used: incision of a. iliaca externa were performed for 332 patients, by means of transcutaneus a. femoralis punction - 248, by means of incision of ascending aorta - 154, and by means of incision of ascending aorta with tourniquets - 10. RESULTS: One hundred seventy nine patients after valve replacement and repair operations were successfully disconnected from intraaortic balloon pumping and 157 (41%) discharged from the hospital. The best results were in aortic valve replacement patients and coronary artery bypass grafting patients 64-67% was disconnected from intraaortic balloon and 64-57% discharged from the hospital. Totally 411 (55%) postcardiotomic patients were successfully disconnected and 373 (50%) discharged from the hospital. Main complications of the treatment by intraaortic balloon pumping were: aortic balloon thrombosis - 34, rupture of balloon - 6, aortic dissection - 4, peripheral artery perforation and aneurysm - 3, bleeding from area of balloon insertion - 2. Intraaortic balloon pumping duration ranged from 3.5 to 141 hours. CONCLUSION: Best results were in patients group with intraaortic balloon pumping who underwent coronary artery bypass grafting and aortic valve replacement. The insertion intraaortic balloon through ascending aorta with tourniquets is more physiological and it is no need of thoracotomy to extract the balloon.

Cardiac Surgical Procedures↗

PubMed2002

[Early and late postoperative results of mitral and tricuspid valve insufficiency surgical treatment using edge-to-edge central coaptation procedure].

Edge-to-edge approximation of the mitral leaflets and creation of a double-orifice mitral valve (Jatene-Alfieri procedure), for mitral regurgitation surgical treatment was effective in most cases, especially for patients who had rheumatic and degenerative valve disease, traumatic or ischemic mitral valve insufficiency. Positive results of double-orifice technique encourages to use this method to correct some forms of tricuspid insufficiency. Triple-orifice repair procedure is a lot more effective to correct central prolapses in all of the three leaflets (extraordinary elongated chordaes) and/or degenerative tricuspid annular dilation than the ordinary routine procedures. This study aims to evaluate early and long-term postoperative outcomes for 29 patients after mitral double-orifice and/or triple orifice repair procedures. It also determines clinical and echocardiographic results at follow-up period for more than two years.

Adult↗