Biatrial Approach Provides Better Outcomes in the Surgical Treatment of Cardiac Myxomas.

Objective: We aimed to present clinical features, surgical approaches, importance of surgical technique and long-term outcomes of our patients with cardiac myxoma who underwent surgery. Methods: We retrospectively collected data of patients with cardiac myxoma who underwent surgical resection between February 1990 and November 2014. Biatrial approach is the preferred surgical method in a large proportion of patients that are operated due to left atrial myxoma because it provides wider exposure than the uniatrial approach. To prevent recurrence during surgical resection, a large excision is made so as to include at least 5 mm of normal area from clean tissue around the tumor. Moreover, special attention is paid to the excision that is made as a whole, without digesting the fragment of tumor with gentle dissections. Results: Forty-three patients (20 males, mean age of 51.7±8.8 years) were included. Most common symptom was dyspnea (48.8%). Tumor was located in the left atrium in 37 (86%) patients. Resections were achieved via biatrial approach in 34 patients, uniatrial approach in 8 patients, and right atriotomy with right ventriculotomy in 1 patient. One patient died due to low cardiac output syndrome in the early postoperative period. Mean follow-up time was 102.3±66.5 months. Actuarial survival rates were 95%, 92% and 78% at five, 10 and 15 years, respectively. Recurrence was observed in none of the patients during follow-up. Conclusion: Although myxomas are benign tumors, due to embolic complications and obstructive signs, they should be treated surgically as soon as possible after diagnosis. To prevent recurrence, especially in cardiac myxomas which are located in left atrium, preferred biatrial approach is suggested for wide resection of the tumor and to avoid residual tumor.

Biatrial approach provides better outcomes in the surgical treatment of cardiac myxomas

Abstract Objective: We aimed to present clinical features, surgical approaches, importance of surgical technique and long-term outcomes of our patients with cardiac myxoma who underwent surgery. Methods: We retrospectively collected data of patients with cardiac myxoma who underwent surgical resection between February 1990 and November 2014. Biatrial approach is the preferred surgical method in a large proportion of patients that are operated due to left atrial myxoma because it provides wider exposure than the uniatrial approach. To prevent recurrence during surgical resection, a large excision is made so as to include at least 5 mm of normal area from clean tissue around the tumor. Moreover, special attention is paid to the excision that is made as a whole, without digesting the fragment of tumor with gentle dissections. Results: Forty-three patients (20 males, mean age of 51.7±8.8 years) were included. Most common symptom was dyspnea (48.8%). Tumor was located in the left atrium in 37 (86%) patients. Resections were achieved via biatrial approach in 34 patients, uniatrial approach in 8 patients, and right atriotomy with right ventriculotomy in 1 patient. One patient died due to low cardiac output syndrome in the early postoperative period. Mean follow-up time was 102.3±66.5 months. Actuarial survival rates were 95%, 92% and 78% at five, 10 and 15 years, respectively. Recurrence was observed in none of the patients during follow-up. Conclusion: Although myxomas are benign tumors, due to embolic complications and obstructive signs, they should be treated surgically as soon as possible after diagnosis. To prevent recurrence, especially in cardiac myxomas which are located in left atrium, preferred biatrial approach is suggested for wide resection of the tumor and to avoid residual tumor.

A comparison of off-pump and on-pump coronary bypass surgery in patients with low EuroSCORE.

BACKGROUND: The aim of the present study was to evaluate and compare postoperative short-term, mid-term and long-term outcomes of coronary artery bypass surgery performed with or without cardiopulmonary bypass in patients with a low European System for Cardiac Operative Risk Evaluation score. METHODS: A retrospective analysis of 478 consecutive low risk patients undergoing coronary bypass surgery between January 2002 and December 2007 was performed. Of these patients, 83 cases had undergone on-pump and 395 cases had undergone off-pump coronary bypass surgery. The patients were assessed in terms peri-operative complications, survival, mortality due to cardiac events, need for rehospitalization and repeated coronary revascularization. RESULTS: There was no significant difference between the two groups in terms of preoperative characteristics, except for chronic obstructive pulmonary disease. The number of distal anastomosis per patient was significantly lower in the off-pump group than in the on-pump group (2.66 ± 0.74 vs. 3.21 ± 0.85, p < 0.001). Early mortality rates were similar in both groups (1.01% for the off-pump group and 1.2% for the on-pump group, p = 0.687). Neurological complications were significantly lower in the off-pump group than in the on-pump group (1.1% vs. 6%, p = 0.01). The mean follow-up period was 80 ± 19.1 months (range, 3-112 months). The need for revascularization during long-term follow-up was 10.1% in the off-pump group and 7.2% in the on-pump group (p = 0.416). The 5-year survival was 95.2 ± 1.1% and 95.5 ± 2.7% in the off-pump and on-pump groups, respectively (p = 0.8), whereas the 7-year survival was 91.9 ± 1.6% and 84.7 ± 6.8% in the off-pump and on-pump groups, respectively (p = 0.274). The 5-year revascularization-free period was 89.5 ± 1.6% and 89.7 ± 3.5% in the off-pump and on-pump groups, respectively (p = 0.785). The 7-year revascularization-free period was 71.1 ± 3.1% and 73.5 ± 7.3% in the off-pump and on-pump groups, respectively (p = 0.075). The 7-year event-free survival was 80.1 ± 2.2% and 73.4 ± 7.3% in the off-pump and on-pump groups, respectively (p = 0.377). CONCLUSIONS: The present study demonstrated that off-pump cardiac surgery had advantages over on-pump cardiac surgery in the short term; however, both interventions had similar mid-term and long-term outcomes, when performed in low-risk patient.

Vascular complications of intra-aortic balloon pump usage in coronary bypass surgery: 18 years of experience.

OBJECTIVE: To evaluate the vascular complication incidence related to intra-aortic balloon pump usage during coronary bypass surgery and possible risk factors. METHODS: The retrospective study was conducted at Uludog University Hospital, Turkey, and comprised 147 cases in which intra-aortic balloon pump was used during coronary artery bypass surgery between January 1994 and December 2011. Data was examined in terms of age, gender, diabetes mellitus, hypertension, smoking, peripheral vascular disease, pre-operative serum creatinine, history of congestive heart failure, left ventricular ejection fraction, previous infarction and cardiac functional capacity. Time, indication, treatment duration, technique of insertion and complications were recorded about the balloon insertion. Patients in whom peripheral vascular complication developed were evaluated with pulse examination, Doppler ultrasound and angiography. Logistic regression analyses were carried out with the purpose of determining the relation between pre-operative clinical variables and vascular complications and mortality. RESULTS: Of the total, 105 (71%) were males and 42 (28%) were females. The overall mean age was 62.4 +/- 10.1 years. Besides, 16 (41%) cases had diabetes mellitus and 30 (20%) had peripheral artery disease. The mean Euroscore was 7.6 +/- 4.8. Intra-aortic balloon pump was inserted in 16 (10.8%) due to pre-operative high risk and in 75 (51%) cases due to hypotension being non-responsive to inotropes. Balloon catheter was placed with percutaneous technique in 141 (96%) cases and sheath wasn't used in 44 (29%). The balloon stayed for 2.9 +/- 2.1 days on average. Balloon rupture developed in 1 (0.6%) case. Mortality resulted in 58 (39%) cases. Euroscore (p=0.012), staying in hospital (p=0.005), low ejection fraction (p=0.018), hypertension existence (p=0.003) in multivariate logistic regression analyses were found significant in terms of affecting mortality. Duration of therapy (p<0.001), existence of sheath (p=0.002), and existence of peripheral vascular disease (p<0.001) were found significant as factors affecting the development of vascular complication. CONCLUSION: Intra-aortic balloon pump provides mechanical circulation assistance during coronary artery surgery, but peripheral vascular system should be well evaluated in order to avoid vascular complications and the balloon catheter should be placed without the sheath if necessary. The duration of the therapy is a risk factor for the development of vascular complication.

Postoperative outcomes after off-pump coronary artery bypass grafting in EuroSCORE low- and high-risk women.

BACKGROUND: Many previous studies have reported that women who undergo coronary artery bypass grafting have higher perioperative morbidity and mortality rates than men. The use of off-pump coronary artery bypass grafting (OPCAB) has been suggested to decrease morbidity and mortality because the deleterious effects of cardiopulmonary bypass, particularly in high-risk patients, are avoided. The reduction in unwanted postoperative complications in women undergoing OPCAB surgery has not been extensively investigated. The aim of this retrospective study was to compare perioperative rates of morbidity and mortality and follow-up events after OPCAB in female patients assessed as high- or low-risk according to the European System for Cardiac Operative Risk Evaluation (EuroSCORE). METHODS: The study included 377 adult female patients who underwent elective primary isolated OPCAB. The study patients were divided into 2 groups based on the Additive EuroSCORE: low-risk patients (group I, n = 301, EuroSCORE < 6) and high-risk patients (group II, n = 76, EuroSCORE > or = 6). RESULTS: Patient ages were 60.1 +/- 7.77 years in group I and 69.3 +/- 5.51 years in group II (P <.001). Compared to group I patients, group II patients had significantly higher Additive EuroSCORE (P <.001), predicted mortality rate (Logistic EuroSCORE) (P <.001), and Canada angina classification (P <.001) and higher rates of preoperative myocardial infarction (P <.001), peripheral vascular disease (P <.001), carotid artery disease (P <.005), and hypertension (P <.05). Occurrence of postoperative arrhythmia and mortality were significantly higher (P <.05) in group II. The observed mortality rate in group I was 1%, which was 41% of the predicted mortality rate (Logistic EuroSCORE) of 2.42 +/- 0.76. The observed mortality rate in group II was 5.3%, which was 79% of the predicted rate (6.74 +/- 2.89), but the difference was not significant (P = .2). Intensive care unit length of stay (P <.01) and ventilation times (P <.05) were longer for group II than group I, and the incidence of conversion to cardiopulmonary bypass was 1.6% versus 5.3%, respectively, in groups I and II (P = .08). CONCLUSION: These results indicate that OPCAB surgery is safe and seems to be an effective surgical technique for lowering rates of morbidity and mortality in high- and low-risk female patients.

Single-stage repair of adult aortic coarctation and concomitant cardiovascular pathologies: a new alternative surgical approach.

BACKGROUND: Coarctation of the aorta in the adulthood is sometimes associated with additional cardiovascular pathologies that require intervention. Ideal approach in such patients is uncertain. Anatomic left-sided short aortic bypass from the arcus aorta to descending aorta via median sternotomy allows simultaneous repair of both complex aortic coarctation and concomitant cardiac operation. MATERIALS: Four adult patients were underwent Anatomic left-sided short aortic bypass operation for complex aortic coarctation through median sternotomy using deep hypothermic circulatory arrest. Concomitant cardiac operations were Bentall procedure for annuloaortic ectasia in one patient, coronary artery bypass grafting for three vessel disease in two patient, and patch closure of ventricular septal defect in one patient. RESULTS: All patients survived the operation and were alive with patent bypass at a mean follow-up of 36 months. No graft-related complications occurred, and there were no instances of stroke or paraplegia. CONCLUSION: We conclude that single-stage repair of adult aortic coarctation with concomitant cardiovascular lesions can be performed safely using this newest technique.

Off-pump bypass grafting in patients with significant left main coronary artery stenosis.

The aim of this study was to investigate and determine whether patients with significant (> or = %50) left main coronary artery stenosis could undergo coronary bypass on the beating heart and compare the results to those obtained using the conventional method. Prospectively collected data of patients with significant left main coronary artery disease who had undergone coronary bypass on the beating heart (group A, n = 100) or with the conventional method (group B, n = 100) were evaluated retrospectively. EuroSCORE values, preoperative and operative details, postoperative morbidity and mortality, and early results were compared. Groups were similar in terms of EuroSCORE, demographics, and preoperative variables. Number of distal anastomoses per patient was 3.1 +/- 0.9 in the beating heart group while it was 3.3 +/- 0.9 in the conventional group ( P = 0.09). Patients operated on with the conventional method had higher levels of peak creatine kinase-myocardial band, blood and blood product transfusions, and inotropic requirements, while mechanical ventilation times and hospital stay were longer. The incidence of postoperative atrial fibrillation, mediastinitis, and intra-aortic balloon usage were comparable between the groups. There was no neurological complication in group A whereas five major neurological complications (three transient ischemic attacks, two strokes) occurred in group B ( P = 0.06). Thirty-day mortality occurred in one patient in the beating heart group whereas five early deaths were observed in the conventional group ( P = 0.21). In significant left main coronary artery stenosis coronary bypass on the beating heart is a safe and effective alternative to the conventional method with the same or better early results. The long-term results need to be evaluated.