Revisional Gastric Bypass After Failed Adjustable Gastric Banding-One-Stage or Two-Stage Procedure?

BACKGROUND: Revisional laparoscopic Roux-en-Y gastric bypass (R-LRYGB) is the preferred procedure after failed adjustable gastric banding. Little is known about whether a one-stage procedure (one surgery for band removal and R-LRYGB) or a two-stage procedure (first band removal and later R-LRYGB) is superior. Aim of this study is to compare early- and long-term results of both methods at our institution. METHODS: Retrospective analysis of 165 (m 26/f 139) consecutive patients (98 one-stage, 67 two-stage) with R-LRYGB. Mean follow-up time was 50.1 ± 38.8 months. Indications for one-stage vs. two-stage procedures, operating time, peri- and postoperative complications, morbidity, mortality, and length of stay (LOS) were analyzed. Data are reported as total numbers (%) and mean ± standard deviation. RESULTS: Mean age at R-LRYGB was 43.9 ± 10.7 vs. 44.3 ± 10.7 years with a BMI of 37.1 ± 6.8 vs. 39.8 ± 7.1 (one-stage vs. two-stage). In the one-stage group, the main indication for revisional surgery was weight regain (57.1%), followed by dilatation of the esophagus or pouch (37.7%) and gastroesophageal reflux disease (GERD) (36.7%), whereas in the two-stage group, it was band erosion (52.2%) and dilatation of the esophagus or pouch (17.9%) and GERD (11.9%). There was no significant difference in operative time (208.5 ± 61.2 vs. 206.3 ± 73.5 min), LOS (8.6 ± 3.4 vs. 9.3 ± 5.7 days) or mortality (0% overall). Major complications (Clavien-Dindo ≥ IIIa) occurred similarly often in both groups: 15.3% vs. 16.9% (one-stage vs. two-stage). CONCLUSION: Both approaches achieve good results. However, the one-stage R-LRYGB is the preferable procedure because it reduces costs and LOS by doing without an additional surgical procedure.

Gender-related differences in patients undergoing mechanical aortic valve replacement with the CarboMedics valve.

AIM: The aim of this paper was to evaluate gender-related differences in patients undergoing mechanical aortic valve replacement with the CarboMedics valve. METHODS: During a 20 year period, 629 patients (median age 60 years) underwent mechanical aortic valve replacement with the CarboMedics valve. Of these, 215 patients were female (34%). The median follow-up for the entire cohort was 10.2 ± 6.2 years. RESULTS: In-hospital mortality for the entire cohort was 9% (male 7.3% vs. female 11.0%, P=0.005). Cox regression analysis revealed redo-surgery (HR=2.35, CI 1.35-4.08), LVEF<30% (HR=2.31, CI 1.36-3.93), age (HR=1.60, CI 1.27-2.02), as well as female gender (HR=2.07, CI 1.28-3.35) as independent predictors of survival. For male gender LVEF<30% (HR=2.47, CI 1.23-4.93) and age (HR=1.75, CI 1.25-2.43) were independent predictors of survival. For female gender, additional CABG (HR=2.15, CI 1.08-4.28), redo surgery (HR=3.64, CI 1.78-7.46) as well as age (HR=1.48, CI 1.06-2.06) were independent predictors of survival. CONCLUSION: Gender per se is an independent risk factor of survival after mechanical aortic valve replacement. Severely impaired LVEF independently predicts survival in males whereas additional CABG and redo surgery do in females. Age affects survival in both sexes. These findings may serve as a basis for further improving gender related outcome.

Results of open heart surgery in Jehovah's Witnesses patients.

AIM: The aim of this paper was to evaluate the results in patients from the religious community of Jehovah's Witnesses (JW) undergoing open heart surgery. METHODS: Between January 1998 and November 2007, 35 patients with a religious background of JW church underwent open heart surgery at the Department of Cardiothoracic Surgery, Medical University of Vienna (Austria). Eighteen patients underwent coronary artery bypass graft (CABG), 11 patients underwent valve surgery and 5 patients underwent combined procedures. One patient underwent isolated ascending aortic replacement. Five patients undergoing CABG were operated without cardiopulmonary bypass (CBP). RESULTS: Mean baseline hematocrit serum levels were 35.8+/-6.3%. The mean decrease of hematocrit serum levels was 20.0+/-21.1% after surgery. The mean decrease of hematocrit serum levels in patients undergoing CABG without CPB was 12.5+/-5.4% and 12.0+/-20.0% in patients after isolated valve replacement. One patient died during the operation. Four patients died in the postoperative period due to anemia. During follow-up, being 34.6+/-34.8 months to date, no cardiovascular related adverse event has been observed. CONCLUSIONS: The decrease of hematocrit serum levels is significantly characterizing the postoperative period of open heart surgery in JW. In patients undergoing CABG without CPB and in patients undergoing isolated valve replacement, decrease of hematocrit serum levels was lowest. Therefore, these techniques should be considered for first choice when appropriate. Furthermore, highly normal preoperative hematocrit serum levels and a meticulous surgical technique remain the mainstay of therapy in these patients.