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Massimo Bonacchi

Publications and source records attributed to Massimo Bonacchi.

17 recordsLinked to original sources
PubMed2003

Anomalous origin of the left pulmonary artery from the aorta. Our experience and literature review.

Three patients with anomalous origin of the left pulmonary artery (AOLPA) from the aorta underwent surgical correction. Two patients presented with an isolated malformation and one with an associated ventricular septal defect. One of the patients with an isolated malformation presented with an AOLPA from the descending thoracic aorta. Implantation of the AOLPA to the main PA trunk was performed by direct anastomosis in two patients and by interposition of a synthetic graft in the other patient with AOLPA from the descending aorta. All patients survived the operation. Low cardiac output was identified in one patient. The mean residual gradient through the anastomotic site was 21 mmHg at follow-up. We found almost 72 cases with AOLPA reported in the literature with a high mortality rate in patients not undergoing surgery. The most frequently found associated malformation is tetralogy of Fallot and ventricular septal defect. AOLPA from the aorta is a rare but important entity, necessitating a scrupulous preoperative and intraoperative evaluation. Patients with AOLPA can undergo surgical repair with excellent results.

Adult↗
PubMed2003

The "omega-anastomosis": a new revascularization technique for coronary bifurcations.

We report the "omega-anastomosis," a new technique permitting the revascularization of both coronary branches beyond a bifurcation by using a single arterial graft. This technique consists of a longitudinal incision in the main coronary artery, which extends to both coronary branches beyond the bifurcation. The arterial conduit's distal extremity is cut vertically and tailored to produce a "bipetal" shape, which is used to enlarge and create an acceptable roof for both coronary branches beyond the bifurcation.

Anastomosis, Surgical↗
PubMed2003

Postoperative outcome in patients with anomalous origin of one pulmonary artery branch from the aorta.

OBJECTIVES: The aim was to review our experience with the surgical repair of the anomalous origin of one pulmonary branch from the aorta (AOPA). MATERIALS AND METHOD: Between January 1991 and March 2002, eight patients with AOPA underwent surgical correction. Three patients presented isolated AOPA. Five patients presented right AOPA and three, left AOPA. Implantation of the AOPA to the main pulmonary artery was performed by: (I) direct anastomosis in two patients with left AOPA; (II) interposition of a synthetic graft in one patient with left AOPA; (III) employing an autologous pericardial patch in two patients with right AOPA; (IV) using an aortic flap in three other patients with right AOPA. The mean follow-up time was 37.7 months. RESULTS: One patient died postoperatively due to progressive heart failure unresponsive to inotropic support. Early postoperative pulmonary hypertension crisis was identified in another patient. Within 1 year after surgery, the mean residual gradient across the anastomotic site at follow-up was 14+/-8 mmHg. The patient undergoing interposition of a synthetic graft presented a residual gradient of 29 mmHg and underwent reoperation at almost 2.5 years after the first correction. The residual gradient in patients undergoing correction according to technique I was 17+/-3 mmHg, and in patients undergoing implantation of the AOPA according to techniques III or IV was 9.5+/-4.6 mmHg (P=0.11). Similarly, the Tc-99m scintigraphy demonstrated that a lower lung perfusion (the lung perfused from the respective AOPA compared with the contralateral lung) in patients undergoing AOPA implantation according to technique I was 59+/-6(%) and in patients undergoing techniques III or IV was 72+/-4.5(%) (P=0.038). At follow-up, all patients were alive. CONCLUSION: The AOPA from the aorta is a rare but important entity, necessitating a scrupulous preoperative and intraoperative evaluation. Patients presenting this anomaly may undergo correction using various surgical techniques with acceptable results. The techniques employing autologous tissues for enlarging and lengthening the AOPA seems to be associated with less restenosis at the anastomotic site, however, larger series of patients are required to confirm such outcome.

Anastomosis, Surgical↗
PubMed2003

Postoperative outcome in patients with accessory mitral valve tissue.

Accessory mitral valve tissue (AcMVT) is a rare congenital malformation causing left ventricular outflow tract obstruction (LVOTO). The analysis of various published reports reveals 90 patients presenting with AcMVT, ranging in age from newborns to 77 years old. Severe LVOTO is present in most cases, though mild LVOTO was found in 15 patients (16.7%), and 3 other patients (3.3%) presented with no LVOTO. In our practice, we found this anomaly in 5 patients; one presenting with severe LVOTO, two with mild LVOTO, and another who developed moderate LVOTO after a myocardial infarction episode. 68 patients (75.5%) underwent cardiac surgery, with a postoperative mortality of 6 (8.9%). Postoperatively, a residual mild gradient across the left ventricular outflow tract was identified in 9 patients (13.2%). Nine other patients (13.2%) required reoperation due to severe LVOTO. Mild-to-moderate postoperative mitral or aortic valve regurgitation was found in 7 (10.3%) and 5 (7.3%) patients, respectively. Based on reported intraoperative findings, we have classified this anomaly as Type I-FIXED TYPE (A - nodular, B - Membranous), Type II-Mobile type (A - Pedunculated, B - leaflet-like). Type IIB is divided into 1) rudimentary chordae and 2) developed chordae. Based in our own experience and after the analysis of various reports, we conclude that patients with AcMVT causing LVOTO may undergo safe mass excision with acceptable postoperative mortality and morbidity. The removal of the AcMVT should in no way compromise mitral valve function, and its excision should be made subject to careful evaluation of the surrounding structures.

Adolescent↗
PubMed2002

Does ministernotomy improve postoperative outcome in aortic valve operation? A prospective randomized study.

BACKGROUND: The aim of this study was to compare the postoperative outcome obtained in patients undergoing elective aortic valve operation, either through ministernotomy or conventional sternotomy. METHODS: Between January 1999 and July 2001, 80 consecutive patients undergoing elective aortic valve replacement were randomly divided into two groups: group I (n = 40 patients) undergoing a ministernotomy approach (reversed-C or reversed-L), and group II (n = 40 patients) undergoing conventional sternotomy. RESULTS: The length of skin incision was significantly shorter in group I than in group II (8.2+/-1.3 cm versus 23.7+/-2.6 cm, p < 0.001). No significant differences were found in cardiopulmonary bypass duration, associated procedures, or aortic cross-clamping times. Total operating time was 3.7+/-0.46 hours in group I compared with 3.4+/-0.6 hours in group II (p = 0.014). A similar incidence of cardiac, neurologic, infective, and renal complications between groups was found. Mean mediastinal drainage and mean blood transfusions (amount of blood transfused) per patient were greater in group II (p < 0.004 and p < 0.001, respectively). Twenty-five (62.5%) patients in group II and 15 (37.5%) patients in group I required postoperative blood transfusion (p = 0.04). Mechanical ventilation time was significantly longer in group II (6.2+/-1.8 hours versus 4.4+/-0.9 hours, p = 0.006). Five days after the surgical procedure, spirometric data analysis demonstrated a significantly lower total lung capacity and maximum inspiratory and expiratory pressures in group II compared with group I (p = 0.003, p = 0.007, and p < 0.001, respectively). CONCLUSIONS: Our results showed that ministernotomy had not only important cosmetic advantages but also beneficial effects in blood loss and transfusion, postoperative pain, and probably in sternal stability. Ministernotomy also improved recovery of respiratory function and allowed earlier extubation and hospital discharge.

Aged↗
PubMed2002

Repair of congenital malformations of the mitral valve: early and midterm results.

BACKGROUND: The aims of this study were to determine early and midterm survival and freedom from reoperation, and to identify the predictors for poor postoperative outcome in children undergoing mitral valve (MV) repair owing to congenital malformations of the mitral valve. METHODS: Between January 1990 and February 2001, 94 consecutive children with congenital MV disease underwent valve repair. The mean age was 5.2+/-3.3 years (range 20 days to 15 years). Twenty-five (26.6%) children were less than 1 year old. Isolated MV disease was found in 21 (22.4%) patients. MV stenosis was the predominant lesion in 21 (22.4%) patients with a mean left atrial to left ventricle diastolic peak gradient of 24.5+/-9.2 mm Hg. MV regurgitation was the predominant pathophysiology in 73 (77.6%) patients with a mean regurgitation grade of 3.3+/-0.7. RESULTS: The hospital mortality was 8.5% (8 of 94). Three patients required permanent pacemaker implantation owing to complete atrioventricular block. Two patients underwent mediastinal exploration for significant bleeding. Postoperatively the echocardiography color Doppler study demonstrated a significantly lower mean end diastolic left atrium to left ventricle gradient 8.7+/-2.2 mm Hg (p < 0.001) in patients with MV stenosis and a mean regurgitation grade of 0.9+/-0.6 (p < 0.001) in patients with MV regurgitation. Actuarial survival and actuarial reoperation-free survival were 89.2% and 76.3%, respectively. Multivariate analysis demonstrated that age less than 1 year (p = 0.035), hammock MV (p = 0.0093), cardiothoracic ratio greater than 0.6 (p < 0.0001), and associated cardiac anomalies (p = 0.003) were strong predictors for poor overall freedom from reoperation and midterm survival. CONCLUSIONS: Mitral valve repair for congenital mitral valve disease yields acceptable early and midterm mortality and reoperation rates. Strong predictors for poor overall freedom from reoperation and midterm survival were age less than 1 year, hammock MV, cardiothoracic ratio greater than 0.6, and associated cardiac anomalies.

Actuarial Analysis↗
PubMed2002

Early and long-term outcome in patients undergoing aortic root replacement with composite graft according to the Bentall's technique.

OBJECTIVE: The aims of this study were: (i) to evaluate the early and long-term outcome in patients undergoing aortic root replacement (ARR) with a composite graft; (ii) to identify the predictors for poor overall survival in this pool of patients. MATERIAL AND METHODS: Between January 1989 and December 2000, 212 patients underwent ARR with a CG. Mean age was 56+/-14 years, ranging from 16 to 77. Annuloaortic ectasia was the most frequent cause of aortic disease in this series, 81 (38%) patients, followed by atherosclerotic aneurysm 57 (27%) and type A acute aortic dissection 52 (24.5%). Marfan's syndrome was present in 37 (17.5%) patients. Duration of follow-up ranged from 1 to 120 months, mean 59+/-35 months. RESULTS: The overall hospital mortality was 16 (7.5%) patients. Eight of them had aortic dissection and four Marfan syndrome. The most frequently found complication resulted to be renal failure in 22 (10%) patients and low cardiac output in 15 (7%) patients. The incidence of perioperative myocardial infarction, neurological complications, respiratory complications, renal failure and coagulopathy incidence were significantly higher in patients with cardiopulmonary bypass (CPB) time >170 min, CA >40 min, and total aortic arch replacement. The actuarial survival at 1, 3 and 5 years resulted to be 91.8, 86 and 81.5%, instead the actuarial survival without re-operation resulted to be 89, 82 and 78%. The actuarial survival in patients with aortic dissection was significantly lower versus non-dissection (P=0.022). The multivariate analysis revealed the aortic dissection (P=0.03), age >65 years (P=0.014), associated coronary artery disease (P=0.002), NYHA functional class>/=3 (P=0.027), LVEF <35% (P=0.002) and total arch reconstruction (P=0.003) as strong predictors for poor overall survival in patients undergoing ARR. CONCLUSIONS: The ARR with a CG offers acceptable early and long-term outcome. The predictors for poor overall survival in patients undergoing ARR seems to be preoperative aortic dissection extended into the aortic arch, older age, depressed left ventricular function and associated coronary artery disease.

Adolescent↗
PubMed2002

Reoperative revascularization of an occluded left subclavian artery and left internal mammary artery ostial stenosis.

An ostial stenosis of the left internal mammary artery graft anastomosed to the left anterior descending artery was responsible for unstable angina in a patient with a previous coronary artery bypass graft. A T-shape arterectomy was performed between the left subclavian artery and left internal mammary artery. Successful revascularization of the lesion was achieved with a carotid-to-subclavian bypass and surgical ostial plasty extending to the proximal left internal mammary graft using a Hemashild a graft. This procedure was performed through a transverse supraclavicular incision to avoid potential hazards of a redo median sternotomy.

Aged↗
PubMed2002

Coronary revascularization after arterial switch operation.

We report two cases presenting bilateral coronary artery obstruction after arterial switch operation. The first patient underwent bilateral internal thoracic artery grafting to the left and right coronary arteries. The other patient, presenting a single coronary ostium, underwent surgical coronary ostial angioplasty in concomitance to proximal arterioplasty of both coronary arteries employing a single "pantaloon" shape autologous pericardial patch. Both patients survived and, at 1 year and 9 months after the coronary revascularization procedures, the coronary angiography demonstrated a good patency of the internal thoracic grafts and excellent ostial plasty results, respectively. A complete literature review of patients undergoing different coronary revascularization procedures after arterial switch operation is reported.

Cardiac Surgical Procedures↗
PubMed2002

A modified 'single patch' technique for complete atrioventricular septal defect correction.

We propose a modified single-patch technique consisting in plication of the patch on the left side, which then is sutured with the free edge of the left atrioventricular valve. The proposed technique offers all the advantages of the single-patch technique and at the same time provides additional tissue for reconstructing appropriately the left atrioventricular valve in cases with leaflet tissue deficiency such as severely dysplastic valve, double orifice left atrioventricular valve. This modification augments the left atrioventricular valve tissue appropriately to the orifice size, promotes leftward displacement and improved coaptation with the mural leaflet.

Cardiac Surgical Procedures↗
PubMed2002

Early and long term outcome of the arterial switch operation for transposition of the great arteries: predictors and functional evaluation.

OBJECTIVES: The aims of this report were to study the early and late outcome in terms of mortality, freedom from reoperation, predictors for late pulmonary stenosis (PAS) and insufficiency of the neo-aortic valve (AVI) in patients with transposition of the great arteries (TGA) undergoing arterial switch operation (ASO). MATERIALS AND METHODS: Between January 1990 and December 2001, 134 patients with TGA underwent ASO. The patients were divided in Group I (n=88)-TGA with intact ventricular septum and Group II (n=46)-TGA with ventricular septal defect (VSD). The pulmonary artery was reconstructed employing the direct anastomosis technique (PT-I) in 21 (15.7%) patients, the double-patch technique (PT-II) in 41 (30.6%), single pantaloon patch (partial circumference) (PT-III) in 46 (34%) and single pantaloon patch (total circumference) (PT-IV) in 35 (26%) patients. The mean follow-up was 3.4+/-1.3 years. RESULTS: The hospital mortality was 17 (12.7%) patients. The mortality in Group I was significantly lower than Group II (P=0.002). The overall actuarial survival at 1, 3 and 5 years follow-up resulted to be 98, 93, and 91.5%, resulting to be significantly higher in Group I (P=0.032). The multivariate analysis revealed the complex TGA (P=0.007), VSD (P=0.032), coronary anomalies (P=0.004), aortic coarctation or hypoplastic aortic arch (P=0.021), left ventricular outflow tract obstruction (LVOTO) or moderate PAS (P=0.041) as strong predictors for poor free-reoperation cumulative survival. A strong inverse correlation was found between the mean trans-pulmonary gradient at follow-up and the age at the operation (r=-0.41, P<0.0001). The univariate analysis revealed the PT-I technique (P=0.002), prior moderate PAS (P=0.0001), and age <1 month (P=0.018) as strong predictors for moderate-to-severe PAS. The neo-AVI incidence was significantly higher in Group II (P=0.011). Predictors for neo-AVI were male sex (P=0.003), preoperative neo-AV Z-score >1 (P<0.001), prior or concomitant operation for aortic coarctation or hypoplastic aortic arch (P=0.001), LV retraining (P=0.003). CONCLUSION: ASO remains the procedure of choice for the treatment of various forms of TGA with acceptable early and later outcome in terms of overall survival and free reoperation. Strong predictors for poor overall free-reoperation survival are complex TGA, VSD, coronary anomalies, aortic coarctation and LVOTO or moderate PAS. The pulmonary artery reconstruction using a single 'pantaloon patch' seems to offer less residual stenosis. Patients with a VSD and a significant mismatch between the neo-aortic root and distal aorta are at a higher risk for developing postoperative neo-AVI.

Abnormalities, Multiple↗
PubMed2002

Reconstructive surgery for congenitally malformed mitral valve.

BACKGROUND AND AIMS OF THE STUDY: The study aims were to evaluate early and mid-term survival and freedom from reoperation in patients with isolated mitral valve (MV) congenital malformation (MVCM) or in association with other cardiac defects, and to identify predictors for poor early and late outcome. METHODS: Between January 1990 and February 2001, 58 children with MVCM underwent MV-conserving surgery; patients were allocated to group I (n = 21) with isolated MVCM, and group II (n = 37) with MVCM and associated congenital heart defects (ACHD). MV stenosis was identified in 10 (48%) group I patients, and 11 (30%) group II patients (p = NS); MV insufficiency was present in 11 (52%) patients in group I, and in 26 (70%) of group II (p = NS). The most frequently found MVCM were annular dilatation (n = 13) cases and elongated chordae (n = 14). Hammock MV was found in nine patients (15%). RESULTS: Six (10%) hospital deaths occurred. Mortality was 5% (n = 1) in group I, and 13% (n = 5) in group II (p = 0.4). Mean repair techniques per patient was 2.05+/-0.4 and 2.3+/-0.3 in groups I and II respectively (p = 0.009). Mechanical ventilation time was 2.1+/-1 and 2.8+/-0.7 days in groups I and II (p = 0.003). The incidence of postoperative mitral regurgitation grade > or =1 was significantly higher in group II (p = 0.008). At five-year follow up, actuarial survival was 91.5% in group I and 86% in group II (p = 0.037). Actuarial reoperation-free survival was 85% in group I and 73% in group II (p = 0.01). Multivariate analysis showed age >12 months (p = 0.033), hammock MV (p = 0.0088) and ACHD (p = 0.0048) were strong predictors for poor event-free survival. CONCLUSION: MV repair for MVCM provides acceptable early and mid-term outcome in terms of mortality and freedom from reoperation. ACHD significantly reduce early and late postoperative survival and freedom from reoperation.

Adolescent↗
PubMed2002

Early postoperative outcome and hemodynamic performance of the sorin pericarbon stentless aortic valve.

BACKGROUND AND AIMS OF THE STUDY: Stentless aortic bioprostheses offer potential advantages in terms of durability and hemodynamic performance. The study aim was to evaluate the early postoperative performance of the Sorin Pericarbon stentless bioprosthesis. METHODS: Between November 1999 and December 2000, 34 patients (12 males, 22 females; mean age 71.2 +/- 4.8 years; range: 48-85 years) underwent aortic valve (AV) replacement with the Sorin Pericarbon stentless bioprosthesis. Twenty-two patients were in NYHA classes III-IV, and 12 were in classes I-II. Twenty-one patients had AV stenosis, nine AV regurgitation, and four mixed pathology. Doppler-echocardiography was performed before surgery, at hospital discharge and at six-month follow up. At this time, 20 patients also underwent echo-Doppler stress testing, with peak transvalvular gradient measured at rest and during exercise. RESULTS: There were two hospital deaths (not valve-related). No significant perioperative complications were recorded. At hospital discharge, the aortic peak gradient was 15.7 +/- 10.6 mmHg; nil or trivial aortic regurgitation was found in three patients. During six months follow up no endocarditis or thromboembolic events were registered. At six months postoperatively, the transvalvular peak gradient showed a small but significant decrease (11.3 +/- 3.5 mmHg at six months, p = 0.036). Mean left ventricular mass index was also decreased significantly (118.4 +/- 28.5 versus 98.4 +/- 17.8 g/m2, p = 0.024). Left ventricular ejection fraction and effective orifice area were not changed significantly during follow up. In patients undergoing exercise testing (mean maximal workload 96 +/- 48 W), the peak aortic gradient was increased (not significantly) at exercise peak (from 14.7 +/- 6.5 to 17.2 +/- 6.7 mmHg, p = 0.086). CONCLUSION: The excellent early postoperative outcome of this experience with the Sorin Pericarbon stentless valve encourages the use of this prosthesis. Long-term follow up and further evaluations are required with regard to hemodynamic performance and durability.

Aged↗
PubMed2002

[Ministernotomy improves the postoperative course in aortic valve replacement].

BACKGROUND: The advantages and the safety aspects of ministernotomy, in aortic valve replacement, are presently under investigation. The aim of this study was to compare the postoperative results between ministernotomy access and standard total sternotomy access. METHODS: Between January 1997 and July 2002, 98 patients underwent elective aortic valve replacement. They were divided into two groups: group Gm (49 patients) undergoing a ministernotomy approach ("reversed C" or "reversed L") and group Gs (49 patients) undergoing conventional total sternotomy. RESULTS: The length of the skin incision was significantly shorter in group Gm (p < 0.001). The total operative time was significantly longer in group Gm (p = 0.02), but no significant differences were found in the cardiopulmonary bypass and aortic cross-clamping times. Mean mediastinal drainage, incidence of bleeding > 800 ml, mechanical ventilation time, intensive care unit stay and hospital stay were significantly greater in group Gs. Five days after the surgical procedure, spirometric analysis demonstrated a significant reduction in total lung capacity, and in maximum expiratory and inspiratory pressures in group Gs compared with group Gm (p = 0.003, p = 0.001, p = 0.01, respectively). CONCLUSIONS: Our results showed that in addition to cosmetic advantages, ministernotomy is also associated with a better outcome in terms of sternal stability, blood loss and transfusions, and postoperative pain. Ministernotomy also improved the recovery of respiratory function, with a shorter mechanical ventilation time and allowed an earlier hospital discharge.

Aortic Valve↗
PubMedDate not supplied

Off-pump total arterial myocardial revascularization according to the right Y-graft configuration.

OBJECTIVES: The aims of this study were as follows: 1) to evaluate the early outcome of the off-pump total arterial myocardial revascularization according to the right y-graft (lambda-graft) configuration and 2) to compare baseline flow and maximum flow between patients undergoing on-pump and off-pump right y-graft (RYG) construction. METHODS: Between December 1998 and January 2001, 47 patients (Group I) and 20 patients (Group II) with three vessel disease underwent on-pump and off-pump coronary artery bypass graft (CABG) respectively according to the RYG configuration. The mean age was 55.5 +/- 4.7 years and 55 +/- 6.4 years in Groups I and II, respectively. The RYG was constructed employing both internal mammary arteries (IMAs) only, in 21 and 8 patients in Groups I and II, respectively, presenting proximal-middle third stenosis of the left anterior descending artery (LAD) and right coronary artery (RCA). The modified RYG configuration employing both IMAs and radial artery (RA) was performed in 26 and 12 patients in Groups I and II, respectively, presenting middle-distal third stenosis of the LAD and distal stenosis of the RCA or posterior descending artery stenosis. Postoperatively all patients underwent transthoracic echo color-Doppler (TTECD) contrast enhanced (by Levovist) before and after adenosine provocative testat one week and three months after operation. RESULTS: There were no hospital deaths. The mean mechanical ventilation was significantly different in Group I versus Group II patients, 18 +/- 4.4 hours versus 13 +/- 5.7 hours, respectively (p = 0.041). The mean intensive care unit stay was 1.5 +/- 0.6 days in Group I and 1 +/- 0.4 days in Group II (p = 0.033). There were no differences between Groups I and II regarding the IMA diameter, mean velocity, and mean flow. At follow-up time, 6 +/- 2.4 months after the surgical procedure, all patients were alive and free of angina. The coronary flow reserve (CFR) at LIMA main stem was significantly higher at three months when compared to the values at one week after the surgical procedure within the same group, (LIMA)CFR (three months) = 2.37 +/- 0.6 versus (LIMA)CFR (one week) = 2.07 +/- 0.4 (p = 0.005) in Group I and (LIMA)CFR (three months) = 2.4 +/- 0.4 versus (LIMA)CFR (one week) = 2.06 +/- 0.3 (p = 0.004) in Group II. Similarly, the CFR at RIMA main stem were significantly higher at three months when compared to the values at one week after the surgical procedure: (RIMA)CFR (three months) = 2.47 +/- 0.7 versus (RIMA)CFR (one week) = 2.1 +/- 0.5 (p = 0.004) in Group I and (RIMA)CFR (three months) = 2.48 +/- 0.5 versus (RIMA)CFR (one week) = 2.08 +/- 0.4 (p = 0.008) in Group II. CONCLUSION: The flow dynamic data, almost identical between patients undergoing off-pump and on-pump total arterial myocardial revascularization (TAMR) according to the RYG configuration, demonstrate that this technique can be applied with excellent results without the employment of cardiopulmonary bypass in selected coronary artery disease patients.

Cardiopulmonary Bypass↗
PubMedDate not supplied

Beating heart ischemic mitral valve repair and coronary revascularization in patients with impaired left ventricular function.

OBJECTIVE: The aim of this study is to evaluate in a cohort of patients with impaired left ventricular (LV) function and ischemic mitral valve regurgitation (MVR), the effects of on-pump/beating heart versus conventional surgery in terms of postoperative mortality and morbidity and LV function improvement. MATERIALS AND METHODS: Between January 1993 and February 2001, 91 patients with LVEF between 17% and 35% and chronic ischemic MVR (grade III-IV), underwent MV repair in concomitance with coronary artery bypass grafting (CABG) Sixty-one patients (Group I) underwent cardiac surgery with cardioplegic arrest, and 30 patients (Group II) underwent beating heart combined surgery. Aortic valve insufficiency was considered a contraindication for the on-pump/beating heart procedure. Mean age in Group I was 64.4 +/- 7 years and in Group II, 65 +/- 6 years (p = 0.69). RESULTS: The in-hospital mortality in Group I was 8 (13%) patients versus 2 (7%) patients in Group II (p > 0.1). The cardiopulmonary bypass (CPB) time was significantly higher in Group I (p < 0.001). In Groups I and II, respectively (p > 0.1), 2.5 +/- 1 and 2.7 +/- 0.8 grafts per patient were employed. Perioperative complications were identified in 37 (60.7%) patients in Group I versus 10 (33%) patients in Group II (p = 0.025). Prolonged inotropic support of greater than 24 hours was needed in 48 (78.7%) patients (Group I) versus 15 (50%) patients (Group II) (p = 0.008). Postoperative IABP and low cardiac output incidence were significantly higher in Group I, p = 0.03 and p = 0.027, respectively. Postoperative bleeding greater than 1000 mL was identified in 24 patients (39.4%) in Group I versus 5 (16.7%) in Group II (p = 0.033). Renal dysfunction incidence was 65.6% (40 patients) in Group I versus 36.7% (11 patients) in Group II (p = 0.013). The echocardiographic examination within six postoperative months revealed a significant improvement of MV regurgitation fraction, LV function, and reduced dimensions in both groups. The postoperative RF was significantly lower in Group II patients 12 +/- 6 (%) versus 16 +/- 5.6 (%) in Group I (p = 0.001). The 1, 2, and 3 years actuarial survival including all deaths was 91.3%, 84.2%, and 70% in Group I and 93.3%, 87.1%, and 75% in Group II (p = ns). NYHA FC improved significantly in all patients from both groups. CONCLUSION: We conclude that patients with impaired LV function and ischemic MVR may undergo combined surgery with acceptable mortality and morbidity. The on/pump beating heart MV repair simultaneous to CABG offers an acceptable postoperative outcome in selected patients.

Aged↗