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J M Maroñas Andrade

Publications and source records attributed to J M Maroñas Andrade.

4 recordsLinked to original sources
PubMed1994

[Myocardial protection: antegrade cardioplegia versus mixed cardioplegia (with right atrial perfusion) in high risk elective coronary surgery. A prospective trial].

INTRODUCTION: It is unclear after review the literature, whether the techniques of retrograde cardioplegia provides more optimal myocardial protection in the setting of coronary surgery that is possible with conventional antegrade cardioplegia, due to inhomogeneous patient subset that appears in clinical trials. PATIENTS AND METHODS: The present clinical study, prospective and randomized was undertaken in 40 patients undergoing high risk myocardial revascularization to compare the efficacy of both techniques. Inclusion criterias were: age > 65 years, unstable angor, multivessel disease and impaired ventricular function. One control group received cardioplegia through the aortic root, and the study group received combined antegrade-retrograde cardioplegia with perfusion into the right atrium. In both groups the vehicle of cardioplegia was oxygenated blood. RESULTS: There were 3 deaths, two in the control group and another one in the study group. Overall operative mortality was 7.3%. Left main coronary stenosis was present in the 2 patients dying in the control group. There were no significant differences between the two groups with regard to the operative and postoperative parameters analyzed; trials to wean off cardiopulmonary bypass, inotropic support, intra-aortic balloon counterpulsation, perioperative myocardial infarction, and levels of myocardial enzymes. There were higher incidence of temporal heart block in patients in study group. CONCLUSIONS: It was difficult to identify any appreciable difference in the clinical efficacy of these two methods of myocardial protection. We review the literature, trying to identify the "better" alternative in the setting of coronary revascularization and different patient subset.

Aged↗
PubMedDate not supplied

[The surgical treatment of aneurysms of the ascending aorta with associated aortic insufficiency. Total replacement with reimplantation of the coronary arteries].

We reviewed our experience with replacement of the ascending aorta and aortic valve with a composite graft and reimplantation of coronary arteries to the tube graft during 8 years interval from April, 1982, to April 1990. 24 patients underwent repair, the mean age was 49.83 years. Annuloaortic ectasia was the most common indication (58.33%), followed by aortic dissection (acute or chronic). Emergency operation was carried out in nine patients with aortic dissection (37.5%) and elective in 15. The mean duration of cardiopulmonary bypass was 118 +/- 4 minutes and of aortic clamping 83.85 +/- 2 minutes. Hospital mortality was 4.17%, reoperation for hemorrhage was 12.5% and perioperative morbidity for other causes was 34.7%. There were one late death. 20 patients were follow-up with a total of 638 patients-months (two patients excluded with insufficient follow-up and one late death). At last follow-up 14 patients were in functional class I. Eight year actuarial survival for the 24 patients was 91%. We believe that replacement of the ascending aorta and aortic valve with a composite graft and coronary arteries reimplantation to the tube graft is more than one satisfactory alternative to supracoronary graft replacement and aortic valve replacement. It offers the advantage of excluding all abnormal aortic tissue, eliminating the risk for later development of complications in the non excluded disease aorta. It supposes the method of choice for patients with anuloaortic-ectasia, aneurysms of the sinuses of Valsalva with aortic insufficiency, and aortic dissection with proximal affectation of coronary arteries and aortic valve.

Adult↗