Biomedical subjects

T Aybek

Publications and source records attributed to T Aybek.

At least 19 recordsLinked to original sources

PubMed2006

Decalcification of the mitral annulus: surgical experience in 81 patients.

OBJECTIVE: Mitral valve surgery in the presence of extensive calcification of the mitral annulus is a technical challenge and increases perioperative risk. This study reviews our experience with decalcification of the mitral annulus in patients undergoing mitral valve reconstruction or replacement. METHODS: From 1995 to 2003, 81 patients (mean age 64 +/- 13 years, 30 male, 51 female) with extensive calcification of the mitral annulus underwent mitral valve repair (n = 42) or replacement (biological n = 20, mechanical n = 19). The mean follow-up was 24 months. Patients presented with a mean EuroSCORE of 7. Concomitant surgical procedures were performed in 62 %. Patient outcomes were retrospectively assessed. RESULTS: Perioperative survival was 97.5 % (n = 79) and hospital survival was 91.3 % (n = 74). Two-year survival was 88.9 %. Eight patients needed reexploration due to bleeding and five patients required prolonged mechanical ventilation. No perioperative stroke was observed. Freedom from reoperation was 90.2 % (n = 73). Early reoperation for recurrent incompetence was necessary in 3 patients and late reoperation in 5 patients. CONCLUSIONS: Despite the elevated perioperative risk and the high risk of reoperation with this procedure, decalcification of the annulus and repair/replacement of the mitral valve could be performed with good clinical results.

Adolescent↗

PubMed2005

Moderate hypothermia (30 degrees C) for surgery of acute type A aortic dissection.

OBJECTIVE: Antegrade cerebral perfusion has proved to be a reliable method of brain protection during surgery of thoracic aneurysms. In addition, the drawbacks of deep hypothermia may be avoided. This study examines the outcome after surgery for acute type A aortic dissections (AAD) using moderate (30 degrees C) systemic hypothermia compared with conventional techniques of cerebral protection. METHODS: Between January 1999 and August 2003, 74 patients underwent repair of acute type A aortic dissection. Moderate systemic hypothermia (30 degrees C) with selective antegrade cerebral perfusion through subclavian artery (group A) was used in 18 patients. Deep hypothermia (20 - 24 degrees C) was employed using either retrograde (18 patients, group B) or antegrade (38 patients, group C) cerebral perfusion. Tube graft replacement was performed in 55, valve-sparing procedure in 8, and composite graft replacement in 11 patients. RESULTS: The 30-day mortality was 5.5 % in group A, 5.5 % in group B, and 15.8 % in group C (A vs. C and B vs. C; p < 0.01). New postoperative permanent neurologic deficit occurred in 5.5 % of patients in group A, 16.7 % in group B, and 13.2 % in group C. Mean chest tube drainage within the first 24 h in groups A, B and C was 703 +/- 338, 1178 +/- 820, and 1447 +/- 802 ml, respectively (A vs. B and A vs. C; p < 0.01). Cardiopulmonary bypass, ICU, and hospital times were significantly shorter in group A. CONCLUSIONS: Selective antegrade cerebral perfusion with moderate systemic hypothermia appears to be a safe and sufficient tool for brain protection during AAD repair. In avoiding deep hypothermia, this technique may help to reduce cardiopulmonary bypass time and hypothermia-related side effects.

Aortic Dissection↗

PubMed2005

Segmental myocardial wall motion during minimally invasive coronary artery bypass grafting using open and endoscopic surgical techniques.

Current options for minimally invasive surgical treatment of single-vessel coronary artery disease include beating heart procedures without cardiopulmonary bypass (CPB) via mini-thoracotomy (MIDCAB) and totally endoscopic robot-assisted techniques (TECAB) with CPB. Both procedures are associated with potential myocardial stress before revascularization, such as single-lung ventilation (SLV), temporary coronary artery occlusion, cardiac luxation, intrathoracic carbon dioxide insufflation, and extended CPB and operating time. In this echocardiographic study we sought to evaluate the extent of intraoperative segmental wall motion abnormalities (SWMA) during MIDCAB and TECAB surgery and to identify factors affecting SWMA. Forty-six patients with single-vessel coronary artery disease were studied. Sixteen patients were operated using the MIDCAB technique and 30 patients with TECAB. In both groups sequential transesophageal echocardiograms were recorded during the entire procedure. Hemodynamic data and oxygenation variables were acquired simultaneously. In both groups, mild but obvious perioperative SWMA were identified and noted to increase during the course of the operation. These SWMA were more pronounced in the TECAB group. Independent of operating time, these changes disappeared completely after revascularization. No significant hemodynamic compromise was observed. We conclude that MIDCAB and TECAB techniques are associated with significant perioperative SWMA. The appearance of more profound SWMA in the TECAB group compared with the MIDCAB patients might have been the result of intrathoracic CO(2) insufflation, as SLV was used in both groups. No persistent SWMA or post-CPB SWMA were apparent in either group. More extensive intraoperative ventricular SWMA was detected in the TECAB group, suggesting that a more frequent risk for right ventricular dysfunction may exist during TECAB procedures.

Blood Gas Analysis↗

PubMed2004

Totally endoscopic coronary artery bypass graft: initial experience with an additional instrument arm and an advanced camera system.

BACKGROUND: Robotically enhanced telemanipulation for totally endoscopic coronary artery bypass does not provide adequate tactile feedback, traction, or countertraction. The exposition of coronary target sites is difficult, the visual field is limited, and the epicardial stabilization may be troublesome. A fourth robotic arm for endothoracic instrumentation has been added to the da Vinci surgical system to facilitate totally endoscopic operations. The stereoendoscope was upgraded with a wide-angle feature. METHODS: The procedure was performed in five patients. Four of these patients had left internal thoracic artery (LITA) to left anterior descending artery (LAD) grafting on the beating heart and the fifth had sequential bypass grafting (LITA to diagonal branch and LAD) on an arrested heart. The additional effector arm of the da Vinci surgical system was brought into the operative field beneath the operating table and used as a second right arm. The wide-angle view was activated by either the console or the patient side surgeon. RESULTS: The mean operative, port placement, and anastomotic times for a beating-heart totally endoscopic coronary artery bypass were 195 +/- 58, 25 +/- 10, and 18 +/- 5 min, respectively. All procedures were free of morbidity and mortality, with satisfactory angiographic control. The sequential arterial bypass grafting procedure was fully completed in totally endoscopic technique. CONCLUSIONS: The additional instrumentation arm and wide-angle visualization are useful technical improvements of the da Vinci surgical system, solving the problem of traction, countertraction, and facilitated exposition of target sites as well as visualization of the surgical field. They provide potential for wider acceptance of totally endoscopic coronary artery bypass grafting in a larger surgical community.

Aged↗

PubMed2003

First report on sequential totally endoscopic thymomectomy and adrenalectomy using computer-enhanced telemanipulation.

BACKGROUND: Laparoscopic adrenalectomy is considered the standard method for removal of benign adrenal tumors, regardless of hormone activity. Minimally invasive surgery for thymomectomy aims at limited approaches, avoiding complete sternotomy or large thoracotomy. METHODS: We report on a case in which totally endoscopic thymomectomy and adrenal gland resection were performed sequentially using a computer-enhanced telemanipulation system within 3 weeks. RESULTS: Operating time was 4.5 h for totally endoscopic adrenalectomy and 1.5 h for totally endoscopic thymomectomy. The patient was transferred to the normal ward on the day of operation after either procedure and had an uneventful recovery. Pathology yielded no malignancy in both cases. CONCLUSION: This report demonstrates the safety and feasibility of various totally endoscopic procedures performed sequentially.

Adenoma↗

PubMed2003

Performance of stentless versus stented aortic valve bioprostheses in the elderly patient: a prospective randomized trial.

OBJECTIVES: Although stentless aortic bioprostheses are believed to offer improved outcomes, benefits remain unsubstantiated. The aim of our study was to compare stentless with stented bioprostheses, with regard to postoperative changes in left ventricular mass and hemodynamic performance, in the elderly patient. METHODS: Forty patients with aortic stenoses, over the age of 75 years, were randomized to receive either the stented Perimount (n=20) or the stentless Prima Plus (n=20) bioprosthesis. Left ventricular mass regression, effective orifice area, ejection fraction and mean gradients were evaluated at discharge, 6 months and 1 year after surgery. RESULTS: Overall a significant decrease in left ventricular mass was found 1 year postoperatively. However, there was no significant difference in the rate of left ventricular mass regression between the groups. Furthermore, 1 year postoperatively, the hemodynamic performance of the valves and the change in the ejection fraction did not differ between the groups. CONCLUSIONS: Our study shows that in a randomized cohort of elderly patients with aortic stenosis, we were not able to detect significant differences, with regard to hemodynamic performance and regression of left ventricular mass, between the stentless and stented valve groups. To our surprise, previously reported findings of non-randomized trials that showed faster and more complete regression of left ventricular mass and hemodynamic benefits of stentless valves were not reproducible.

Aged↗

PubMed2003

Thoracic epidural anesthesia does not influence the incidence of postoperative atrial fibrillation after beating heart surgery.

BACKGROUND: At least 20 - 30 % of patients undergoing coronary artery bypass graft surgery (CABG) or beating-heart surgery develop postoperative atrial fibrillation (AF). We evaluated the effect of thoracic epidural anesthesia (TEA) on the occurrence of postoperative AF in patients submitted to CABG without cardiopulmonary bypass (OPCABG). METHODS: We performed a retrospective analysis of 125 patients undergoing myocardial revascularization. Early postoperative incidence of AF was compared between three groups of patients - 50 after conventional CABG, 45 after OPCABG, and 30 after OPCABG combined with TEA intraoperatively and postoperatively. Clinical profile of the patients, including factors with a potential influence on postoperative AF was matched for groups. RESULTS: Postoperative AF occurred in 13.3 % of the TEA-treated patients, in 17.7 % of the patients in the OPCABG group, and in 26 % of the patients in the CABG group. This difference did not carry any statistical significance. Risk factors and incidence of postoperative complications were comparable in all groups. CONCLUSION: TEA has no effect on the incidence of postoperative AF in patients undergoing beating-heart surgery.

Aged↗

PubMed2003

Cardiopulmonary bypass impairs left ventricular function determined by conductance catheter measurement.

OBJECTIVE: Postoperative cardiac depression is attributed to ischemia and the effects of cardiopulmonary bypass (CPB). To evaluate the effect of CPB alone on postoperative left ventricular (LV) dysfunction, we used a conductance catheter to determine the LV performance by pressure-volume relation before and after CPB. METHODS: Twenty-two 3-week-old piglets underwent sternotomy and normothermic CPB for one hour. A conductance catheter was placed in the LV cavity. End-systolic pressure-volume relationships (ESPVR), left ventricular end-diastolic pressure (LVEDP) and systemic vascular resistance (SVR) were measured under steady-state conditions before and 15 min after weaning from CPB in group A (n = 11). Group B included 11 piglets without CPB and served as control. RESULTS: There was no difference between groups before initiating CPB. As an indication of depressed LV function, the ESPVR slope (mmHg/ml) was significantly lower in group A after weaning from CPB than in group B (1.69 +/- 0.5 vs. 1.86 +/- 0.55; p = 0.008). In group A, peak dP/dt (max index) (mmHg/s/m (2)) decreased markedly (1596 +/- 339 vs. 2045 +/- 206; p = 0.03), while LVEDP (mmHg) was significantly increased (11.7 +/- 2.6 vs. 5.4 +/- 0.9; p < 0.0001). In addition, SVR (index) (dyn x s x cm (-5)/m (2)) in group A was significantly lower (1407 +/- 176 vs. 1677 +/- 313; p < 0.0001) than in group B. CONCLUSION: Using the very sensitive conductance catheter technique in a pig model, we could show that CPB leads to a significant depression of LV contractility and elastance even without ischemic arrest.

Animals↗

PubMed2002

[Coronary bypass operation with complete median sternotomy in awake patients with high thoracic peridural anesthesia].

OBJECTIVE: High thoracic epidural anesthesia (TEA) combined with general anesthesia is increasingly being used for coronary artery bypass grafting (CABG) with extracorporeal circulation. Recent developments in beating heart techniques have rendered the use of TEA alone in conscious patients possible and have been reported for single-vessel beating heart CABG via lateral thoracotomy. For multi-vessel revascularization the heart is usually approached via median sternotomy, therefore the use of TEA alone was applied in awake patients with multi-vessel coronary artery disease who underwent CABG via median sternotomy. METHODS: A total of 10 patients scheduled for awake coronary artery bypass grafting (ACAB) received TEA via an epidural catheter placed at T1/2 or T2/3. Total arterial myocardial revascularization was performed after median sternotomy. In addition to standard monitoring, anesthetic sensory and motor block levels were determined using an epidural scoring scale for arm movements (ESSAM). RESULTS: Except for one patient who required intraoperative endotracheal intubation due to a pneumothorax, all patients were awake and maintained spontaneous breathing during the entire procedure. Compared to baseline values, hemodynamic parameters, e.g. arterial blood pressure (SAP, MAP, DAP) and heart rate significantly declined during coronary anastomosis. No significant hypercarbia was observed. The intraoperative pain level was subjectively estimated by the patients as less than 20 out of 100 (median 10.95% confidence interval 4.2-21.6) using a visual analogue scale. All patients rated TEA as "good" or "excellent." Adverse effects associated with TEA were not observed. CONCLUSIONS: We could demonstrate that the use of TEA alone for CABG via median sternotomy was feasible and produced good results. High patient satisfaction in our small and highly selected cohort could be reported. Nevertheless, randomized controlled trials in large cohorts are mandatory to definitively evaluate the role of TEA alone in cardiac surgery.

Aged↗

PubMed2002

[Total arterial bypass operations with complete sternotomy in the awake patient].

BACKGROUND: In minimally invasive coronary artery bypass surgery beating heart procedures and operations via limited incisions became more popular and are routinely performed in many centers. An additional approach to minimize general trauma is avoidance of general anesthesia endotracheal intubation. PATIENTS AND METHODS: Between March and June 2001, 14 spontaneously breathing patients underwent coronary artery bypass grafting on the beating heart without general anesthesia. Intra- and postoperative analgesia management was performed using continuous epidural infusion of local anesthetics at level Th2-Th3. Single (n = 8) as well as double (n = 5) and triple (n = 1) bypass grafting was performed with the off pump technique. Surgical access to the chest cavity was created via partial (n = 8) or complete sternotomy (n = 6). RESULTS: Twelve patients remained awake throughout the procedure; 2 patients required secondary intubation due to incomplete sensory block and pneumothorax. Operating time was 94 +/- 18 minutes. Intermediate care monitoring time amounted to 4.8 +/- 0.6 hours. No surgery-related complications or myocardial infarction occurred. Postoperative angiography reviewed good graft function in all patients. CONCLUSION: Our preliminary experience shows that complete surgical revascularization is safe and feasible without endotracheal intubation and general anesthesia. Thus, invasiveness in cardiac surgery is further reduced with less need for intensive care unit monitoring enabling faster mobilization and recovery.

Aged↗

PubMed2002

Five-year experience with valve sparing surgery for aortic root aneurysms.

BACKGROUND: The aim of this study was to analyze the mid-term results of aortic root reconstruction. METHODS: Between September 1995 and March 2001, 32 patients (25 males, 7 females, median age 58 +/- 21 years) underwent aortic root reconstruction as described by T. David. Indications for operation were aortic insufficiency with ascending aortic aneurysm in 27 patients, and acute aortic dissection (Stanford type A) in 5 patients. In all patients the native valve was preserved and suspended inside a tubular prosthesis with reimplantation of the coronary arteries. In 10 patients the classic reconstruction technique was modified by shaping a "Neosinus." RESULTS: There was one perioperative death due to myocardial infarction. Two patients suffered a stroke. 26 patients were followed up 12 months postoperatively. 22 out of 26 patients were in NYHA functional class I, 2 patients in class II and the remaining 2 in class III. Three patients died in the postoperative period. Six patients had trivial AR, 4 mild and 1 moderate regurgitation. There were no thromboembolic events during follow up. The mean transvalvular gradient was 3.5 +/- 2.2 mmHg. Compared to a normal cohort of patients (n = 20), resuspended aortic valves opened (26.4 +/- 5.8 vs. 61.3 +/- 22.1 cm/sec, p < 0.0001) and closed (22.8+/- 6.9 vs. 57.9 +/- 22.3) at a higher speeds and also showed shorter opening (0.053 +/- 0.12 vs. 0.023 +/- 0.09 sec, p < 0.0001) and closing times (0.051 +/- 0.07 vs. 0.23 +/- 0.07 cm/sec) of the aortic leaflets. CONCLUSIONS: Aortic valve reimplantation is a reliable technique able to reduce long term complications when compared to conventional composite graft replacement of the aortic root. Altered leaflet opening and closing dynamics do not impair midterm durability.

Adolescent↗

PubMed2002

Computer-enhanced telemanipulation enables a variety of totally endoscopic cardiac procedures.

BACKGROUND: Since its introduction in the field of cardiac surgery in 1997, computer-enhanced telemanipulation has been used in a number of different specialized areas. In cardiac surgery, various procedures have been successfully completed in totally endoscopic fashion ever since. Between June 1999 and January 2002, 75 closed-chest cardiac procedures have been performed at our institution using the da Vinci telemanipulation system. PATIENTS AND METHODS: In 42 patients, a single-vessel totally endoscopic coronary artery bypass was performed on the arrested heart (left internal thoracic artery (LITA) to left anterior descending artery (LAD), n = 36; right internal thoracic artery (RITA) to right coronary artery (RCA), n = 6). 12 patients had different types of multivessel revascularization using both internal thoracic arteries. 8 patients underwent LITA-to-LAD grafting on the beating heart. 10 patients underwent closure of an atrial septal defect (9 direct, 1 patch). 3 patients received an epicardial left ventricular pacemaker lead, 2 of which were reoperations. RESULTS: Overall conversion rate to any kind of incision was 25 %. The last 26 LITA to LAD patients on the arrested heart had a conversion rate of 4 %. There were no mortalities, 3 patients required reexploration via a median sternotomy, and one patient suffered a hypoxemic brain damage. The first 22 TECAB patients demonstrated excellent graft patency in angiographic control upon discharge. None of the atrial septal defect (ASD) closures showed any residual shunt on the intraoperative transesophageal echocardiogram (TEE). Patients with end-stage heart failure had successful biventricular stimulation. CONCLUSION: Our current experience confirms the feasibility of various totally endoscopic cardiac procedures with good clinical outcomes. After a steep learning curve, the conversion rate could be lowered to an acceptable figure. Some of these procedures at our institution became a reasonable treatment alternative in selected patients.

Coronary Artery Bypass↗

PubMed2002

Totally endoscopic coronary artery bypass grafting on cardiopulmonary bypass with robotically enhanced telemanipulation: report of forty-five cases.

BACKGROUND: Robotically enhanced telemanipulation is a new powerful tool for minimally invasive procedures that allows totally endoscopic cardiac surgery. Between June 1999 and February 2001, 45 robotically enhanced totally endoscopic coronary artery bypass grafting procedures on the arrested heart were performed at our institution with the use of the da Vinci telemanipulation system (Intuitive Surgical, Inc, Mountain View, Calif). METHODS: In 37 patients a single-vessel totally endoscopic coronary bypass operation was performed. Eight patients had different types of multivessel revascularization with both internal thoracic arteries. The initial conversion rate was 22% and dropped to 5% in the last 20 patients. Two patients required reexploration via median sternotomy. The first 22 patients had excellent graft patency on discharge. The procedural time for single-vessel totally endoscopic bypass was 4.2 +/- 0.4 hours, bypass time was 136 +/- 11 minutes, and aortic crossclamp time amounted to 61 +/- 5 minutes. CONCLUSION: The present data show the feasibility of closed chest single- and double-vessel revascularization, with good clinical results. However, procedural time is prolonged and the complex endoscopic and endoaortic occlusion techniques, as well as the extensive anesthesiologic monitoring, are demanding. The need for conversion to an open procedure diminished after a relatively short learning curve. All postulated benefits of totally endoscopic surgery other than excellent cosmesis must be evaluated in larger cohorts.

Aged↗

PubMed2002

Transesophageal echocardiography or fluoroscopy during port-access surgery?

INTRODUCTION: In Port-Access cardio-surgical procedures, both intraoperative transesophageal echocardiography (TEE) and fluoroscopy can be used for placement of the catheters and cannulae needed for cardiopulmonary bypass. Our study sought to clarify whether it is possible to rely exclusively on TEE for catheter placement without increasing the risk for the patient. MATERIALS AND METHODS: Forty patients underwent cardiac surgery with the Port-Access system. Fluoroscopy as well as TEE were used for placement of the transjugular and transfemoral catheters required for cardiopulmonary bypass. The time required for fluoroscopy was recorded, as were any complications during cannulation and cardiopulmonary bypass. RESULTS: The average fluoroscopy time was 10.7 +/- 12.1 min. Fluoroscopy time required for placement of the coronary sinus and pulmonary vent catheters could be reduced to zero early in the course of the study. Once we had gained enough experience with TEE, fluoroscopy for placement of the transfemoral catheters was also no longer necessary. During cannulation, 3 patients suffered complications requiring immediate surgical intervention. These complications were all diagnosed by TEE. CONCLUSION: Our data suggest that positioning of the coronary sinus and the pulmonary vent catheters is safe and practicable with TEE alone. Nonetheless, if TEE imaging is poor or fails, fluoroscopy has still a place in Port-Access surgery and should always be available intraoperatively.

Aged↗

PubMed2002

Echocardiographic findings in minimally invasive coronary artery bypass grafting: The role of intrathoracic CO2 - insufflation and single lung ventilation.

BACKGROUND: Current options for surgical treatment of coronary single vessel disease range from beating heart procedure without cardiopulmonary bypass via a mini thoracotomy (MIDCAB) to totally endoscopic robot-assisted techniques (TECAB) with cardiopulmonary bypass. Both procedures are associated with considerable stress even before revascularization such as single lung ventilation, temporary coronary occlusion, Luxatio cordis, intrathoracic CO2 insufflation and extended bypass and operating time. The aim of the this study was to document the extent of intraoperative segmental wall motion abnormalities (SWMA) by echocardiography, and to identify variables affecting SWMA. MATERIALS AND METHODS: Forty patients with coronary single vessel disease were included in the study. 16 patients were operated with the MIDCAB technique, and 24 patients underwent TECAB. In both groups of patients sequential transesophageal echocardiograms (2D-loops) were recorded and analyzed. Hemodynamic and electrocardiographic data as well as oxygenation parameters were acquired during echo exams. In both groups of patients mild, but significant perioperative SWMA were identified, which increased in the course of the operation. These SWMA were more pronounced in the TECAB as compared to the MIDCAB group. Independent of operating time these changes disappeared completely until the ends of surgery. Significant hemodynamic or elektrocardiographic modifications were not observed. CONCLUSION: The application of minimally invasive techniques for the surgical treatment of coronary single vessel disease is associated with significant perioperative SWMA. The more pronounced SWMA in the TECAB group may be a consequence of intrathoracic CO2-insufflation. Both techniques can be applied without significant myocardial ischemia, provided that appropriate intraoperative monitoring is performed, and intrathoracic CO2 pressure in TECAB patients is limited.

Blood Gas Analysis↗

PubMed2001

Computer-enhanced totally endoscopic sequential arterial coronary artery bypass.

Minimally invasive coronary artery bypass grafting of the anterior wall using a left anterior small thoracotomy became a routine procedure within the last 3 years. The introduction of robotics into the cardiosurgical practice in 1998 has finally enabled totally endoscopic closed chest procedures. We report two patients with totally endoscopic left internal thoracic artery bypass grafting to the left anterior descending artery and the first diagonal branch in sequential arterial revascularization technique using the daVinci surgical system.

Cardiopulmonary Bypass↗

PubMed2001

Abdominal complications after cardiac surgery.

OBJECTIVE: Abdominal complications after cardiac surgery are associated with a high mortality rate. Due to the absence of early specific clinical signs, diagnosis is often delayed. The present study seeks to determine predictive risk factors for subsequent gastrointestinal complications after cardiosurgical procedures. METHODS: Within 12 months, all patients (n = 1,116) who had undergone open heart surgery with cardiopulmonary bypass at our institution were studied for abdominal complications. To determine predictive factors, all case histories of the patients were analysed. RESULTS: Abdominal complications occurred in 23 (2.1%) patients during the postoperative intensive care unit (ICU) stay, ten of whom had to undergo subsequent abdominal surgery. Of these 23 patients, 20 died. Early complications occurred most likely on postoperative days 6 and 7, consisting of bowel ischaemia or hepatic failure. Late complications consisted of gastrointestinal bleeding, pseudomembraneous colitis, cholecystitis and septic rupture of a spleen. The relative risk for abdominal complications after cardiopulmonary bypass was highly increased in association with a cardiac index less than 2.0 l/min-1/(m2)-1 (22.1-fold), postoperative onset of atrial fibrillation (16.6-fold), emergency surgery (10.7-fold), need for vasopressors (10.1-fold), need for intra-aortic balloon counterpulsation (8.6-fold), and the need for re-exploration within the first 24 hours (8.4-fold). All patients with necrotic bowel disease had elevated serum lactate levels. Furthermore, both cardiopulmonary bypass and aortic clamping times were significantly prolonged in patients who developed gastrointestinal complications. CONCLUSIONS: A number of predictive factors has been described to contribute to the development of abdominal complications subsequently after cardiac surgery on cardiopulmonary bypass. Knowledge of these factors may lead to earlier identification of patients at increased risk and may allow for more efficient and earlier interventions.

Abdomen↗

PubMed2000

Mitral valve annuloplasty: comparison of the mural annulus shortening suture (MASS) with the Carpentier-Edwards prosthetic ring.

BACKGROUND AND AIM OF THE STUDY: Although mitral annuloplasty is an important element of mitral valve repair, the technique employed remains controversial. In this prospective study, we compared two different annuloplasty techniques with regard to hemodynamic performance. METHODS: Between October 1995 and December 1998, 109 consecutive patients underwent mitral valve repair for mitral regurgitation. One group of patients (n = 55) received a Carpentier-Edwards (CE) ring for annuloplasty, and a second group (n = 54) underwent the mural annulus shortening suture (MASS) to reinforce the posterior circumference of the annulus. All patients were investigated prospectively by Doppler echocardiography before discharge and annually thereafter. The mean follow up was 22.7+/-11.6 months. RESULTS: The early mortality rate was 3.7%, with four early deaths in the CE group, and no early death in the MASS group. There was one late death in each group. One patient in each group required reoperation for severe mitral regurgitation after 19 and 30 months, respectively. Postoperative (12 months) Doppler echocardiography showed mean mitral valve gradients to be significantly lower (1.7+/-0.7 versus 2.7+/-1.7 mmHg; p <0.01) and mitral valve areas significantly larger (3.3+/-1.0 versus 2.6+/-0.7 cm2; p <0.01) in MASS patients compared with CE patients. There was no significant difference in mean postoperative mitral regurgitation between the two groups (0.5+/-0.2 versus 0.4+/-0.2). CONCLUSION: Both annuloplasty techniques showed excellent results; however, hemodynamic performance of MASS was superior to that of the rigid CE ring, while not increasing postoperative mitral regurgitation. Therefore, MASS may be recommended as an alternative to annuloplasty rings, if future long-term follow up studies confirm the durability of the technique.

Echocardiography, Doppler↗