[The intraaortic balloon pumping--old problems and innovation]. / Intraaortine kontrapulsacija. Senos problemos ir naujoves.

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.

[Early and late postoperative results of mitral and tricuspid valve insufficiency surgical treatment using edge-to-edge central coaptation procedure]. / Mitralinio ir triburio voztuvu nesandarumo korekcijos centrines buriu koaptacijos metodu ankstyvieji ir velyvieji rezultatai.

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.

[Total and partial arterial revascularization]. / Visiska ir daline arterine revaskulizacija.

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.

[Coronary reoperations]. / Pakartotine miokardo revaskulizacija.

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.

[Coronary artery revascularization without cardiopulmonary bypass]. / Vainikiniu arteriju revaskulizacija nenaudojant dirbtines kraujo apytakos.

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.