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1.
Article in English | MEDLINE | ID: mdl-38580322

ABSTRACT

BACKGROUND: Severe tricuspid regurgitation (TR) adversely affects long-term survival; however, isolated tricuspid valve (TV) surgery has been rarely performed due to high operative mortality. In addition, the previous literature included heterogeneous TR etiologies. Therefore, we aimed to elucidate early and long-term outcomes of isolated TV surgery for functional TR. METHODS: An electronic search was performed to identify all relevant studies. Baseline characteristics, perioperative variables, and clinical outcomes were extracted and pooled for meta-analysis. RESULTS: This meta-analysis included seven studies. Pooled analyses showed that 68% (35, 89) of patients had preoperative atrial fibrillation or flutter, and 58% (11, 94) had a history of left-sided valve surgery. Seventy-three percent (65, 80) of patients had at least one physical exam finding of right-sided heart failure, and 57% (44, 69) were in New York Heart Association class III or IV. TV replacement was more common than repair. In TV replacement, bioprosthetic valve (39%, 13, 74) was more common than mechanical prosthesis (22%, 18, 26). The early mortality rate was 7%. Twenty percent of patients required a permanent pacemaker postoperatively. The overall 1- and 5-year survival rates were 84.5 and 69.1%, respectively. CONCLUSION: More than half of the patients who underwent isolated TV surgery for functional TR had undergone left-sided valve surgery and had significant heart failure symptoms at the time of surgery. Further studies on the surgical indication for concomitant TV surgery at the time of left-sided valve surgery and the appropriate timing of surgery for isolated functional TR are needed to improve survival.

2.
Article in English | MEDLINE | ID: mdl-37902828

ABSTRACT

We demonstrate a totally endoscopic and percutaneous approach to robotic mitral valve re-repair after the failure of transcatheter edge-to-edge repair.


Subject(s)
Cardiac Surgical Procedures , Robotic Surgical Procedures , Humans , Mitral Valve/surgery , Surgical Instruments
3.
Article in English | MEDLINE | ID: mdl-37541574

ABSTRACT

OBJECTIVE: Owing to a lack of supportive data, tricuspid regurgitation (TR) is usually not addressed in patients undergoing coronary artery bypass grafting (CABG). Here we evaluated changes in TR degrees over time and its impact on survival in patients undergoing CABG. METHODS: We reviewed the data of 9726 patients who underwent isolated CABG between January 2000 and January 2021. According to preoperative TR severity, patients were stratified into nonsignificant (none to trivial, mild) and significant (moderate to severe) TR groups. We excluded patients who had undergone previous tricuspid valve surgery, pacemaker placement, and concomitant valve or ablative surgery. Propensity score matching and Cox proportional hazards models were used to identify associations between TR grade and the primary outcome of all-cause mortality. The secondary outcome was change in TR severity on the last echocardiogram. RESULTS: After propensity score matching, 380 patients in each group were identified. At baseline, 359 patients had moderate TR (94.5%) and 21 (5.5%) had severe TR. On the last follow-up echocardiogram, TR had improved in 40.5% of the patients in the significant TR group. Kaplan-Meier survival curves showed significantly lower survival in patients with significant preoperative TR compared to those with nonsignificant TR (P < .001). After adjusting for other confounders, survival was no worse in the patients with significant TR group (hazard ratio, 1.05; 95% confidence interval, 0.80-1.38; P = .70). CONCLUSIONS: Significant preoperative TR improved in 40.5% of patients after isolated CABG. After adjusting for other factors, significant TR did not affect long-term survival.

4.
Gen Thorac Cardiovasc Surg ; 71(12): 723-729, 2023 Dec.
Article in English | MEDLINE | ID: mdl-37310563

ABSTRACT

OBJECTIVE: Although an ultrasonic harmonic scalpel (HS) has been used to harvest the internal mammary artery (IMA) for coronary artery bypass grafting, the benefits and risks compared to conventional electrocautery (EC) are not clear. We aimed to compare the outcomes of HS versus EC for IMA harvesting. METHODS: An electronic search was performed to identify all relevant studies. Baseline characteristics, perioperative variables, and clinical outcomes were extracted and pooled for meta-analysis. RESULTS: This meta-analysis included 12 studies. Pooled analyses demonstrated that both groups had comparable preoperative baseline characteristics including age, gender, and left ventricular ejection fraction. HS included more diabetic patients [33% (95% CI 30, 35) vs. 27% (23, 31), p = 0.01]. Harvest time for unilateral IMA was significantly longer with HS than EC [39 (31, 47) minutes vs. 25 (17, 33) minutes, p < 0.01]. However, the rate of pedicled unilateral IMA was significantly higher for EC compared with HS [20% (17, 24) vs. 8% (7, 9), p < 0.01]. The rate of intact endothelium was significantly higher with HS than EC [95% (88, 98) vs. 81% (68, 89), p < 0.01). There was no significant difference in postoperative outcomes including bleeding [3% (2, 4)], sternal infection [3% (2, 4)], and operative/30-day mortality [3% (2, 4)]. CONCLUSIONS: HS required longer IMA harvest times which could be partially attributed to a higher skeletonization rate in this category. HS may cause less endothelial injury than EC; however, no significant differences in postoperative outcomes were seen between the groups.


Subject(s)
Mammary Arteries , Ultrasonics , Humans , Stroke Volume , Ventricular Function, Left , Electrocoagulation/adverse effects
5.
Innovations (Phila) ; 18(1): 90-96, 2023.
Article in English | MEDLINE | ID: mdl-36802961

ABSTRACT

Previous studies have shown that the endoaortic balloon occlusion (EABO) can provide satisfactory aortic cross-clamping with comparable surgical outcomes to thoracic aortic clamping in the setting of minimally invasive and robotic cardiac surgery. We described our approach to EABO use in totally endoscopic and percutaneous robotic mitral valve surgery. Preoperative computed tomography angiography is required to evaluate the quality and size of the ascending aorta, identify access sites for peripheral cannulation and endoaortic balloon insertion, and screen for other vascular anomalies. Continuous bilateral upper extremity arterial pressure and cranial near-infrared spectroscopy monitoring are essential to detect obstruction of the innominate artery due to distal balloon migration. Transesophageal echocardiography is needed for continuous monitoring of balloon positioning and antegrade cardioplegia delivery. Direct fluorescent visualization of the endoaortic balloon on the robotic camera allows for verification of balloon and efficient repositioning if needed. The surgeon should assess hemodynamic and imaging information simultaneously during the balloon inflation and delivery of antegrade cardioplegia. Aortic root pressure, systemic blood pressure, and balloon catheter tension affect the position of the inflated endoaortic balloon in the ascending aorta. The surgeon should eliminate all slack in the balloon catheter and lock it into position to prevent proximal balloon migration after the completion of antegrade cardioplegia. Using scrupulous preoperative imaging assessment and continuous intraoperative monitoring, the EABO can achieve adequate cardiac arrest in totally endoscopic robotic cardiac surgery, even in patients with previous sternotomy without compromise of surgical outcomes.


Subject(s)
Balloon Occlusion , Cardiac Surgical Procedures , Robotic Surgical Procedures , Humans , Robotic Surgical Procedures/methods , Cardiac Surgical Procedures/methods , Endoscopy , Balloon Occlusion/methods , Mitral Valve/surgery , Minimally Invasive Surgical Procedures
6.
Gen Thorac Cardiovasc Surg ; 69(1): 1-7, 2021 Jan.
Article in English | MEDLINE | ID: mdl-32562053

ABSTRACT

OBJECTIVE: The optimal surgical strategy for atrial functional mitral regurgitation remains uncertain. Preoperative mitral-septal angle ≤ 70° has been reported as a risk factor for an abnormal vortex pattern in mitral valve repair. This study aimed to elucidate the change in the mitral-septal angle after surgery for atrial functional mitral regurgitation and its effect on the mid-term outcomes. METHODS: Forty patients underwent mitral valve repair for atrial functional mitral regurgitation. The mitral-septal angle was defined as the angle between the mitral annulus and the anteroseptal wall of the left ventricular mid-portion in the parasternal long-axis view on transthoracic echocardiography. All patients underwent mitral ring annuloplasty. Left atrial plication was performed in nine patients. The mean clinical follow-up period was 42 ± 24 months. RESULTS: The ratio of left atrial volume to left ventricular end-systolic volume was negatively correlated with the preoperative mitral-septal angle. The postoperative mitral-septal angles were significantly smaller than the preoperative ones. The mitral-septal angle decreased with a decrease in the mitral annuloplasty ring size. Patients who underwent left atrial plication tended to show an increase in the mitral-septal angle postoperatively. There were no significant differences in mid-term morbidities, including heart failure, requiring re-hospitalization and mortalities between patients with postoperative MSA > 70° and those with postoperative MSA ≤ 70°. CONCLUSIONS: Mitral ring annuloplasty negatively changed the mitral-septal angle, while left atrial plication may induce a positive change to the mitral-septal angle. An association between the mitral-septal angle and mid-term outcomes was not revealed in this study.


Subject(s)
Heart Valve Prosthesis Implantation , Mitral Valve Annuloplasty , Mitral Valve Insufficiency , Heart Atria/diagnostic imaging , Heart Atria/surgery , Heart Valve Prosthesis Implantation/adverse effects , Humans , Mitral Valve Annuloplasty/adverse effects , Mitral Valve Insufficiency/diagnostic imaging , Mitral Valve Insufficiency/surgery , Retrospective Studies , Treatment Outcome
8.
Interact Cardiovasc Thorac Surg ; 31(6): 813-819, 2020 12 07.
Article in English | MEDLINE | ID: mdl-33164059

ABSTRACT

OBJECTIVES: Our goal was to determine the early and midterm outcomes after total arch replacement with the frozen elephant trunk (FET) technique compared to those of the conventional elephant trunk (ET) technique for acute retrograde type A aortic dissection. METHODS: Between 2012 and 2019, a total of 49 patients had total arch replacement for acute retrograde type A aortic dissection. Patients were divided into the conventional ET (n = 17) and FET (n = 32) groups. The false lumen status was evaluated using enhanced computed tomography (CT) 1 week postoperatively. The diameter of the downstream aorta was evaluated annually using CT. The median follow-up period was 29 months. RESULTS: Preoperative data and neurological complications were not significantly different in the 2 groups. The diameter and length of the ET prosthesis were significantly larger and longer in the FET group. The overall early mortality rate was 10.2% (5/49) with no differences between the 2 groups. The mean follow-up period was significantly longer in the conventional ET group. The rates of freedom from aortic events at 3 years were significantly lower in the FET group. At the level of the distal arch, postoperative false lumen patency was significantly lower and the follow-up aortic diameter was significantly smaller in the FET group. CONCLUSIONS: The FET technique facilitates false lumen thrombosis and aortic remodelling at the distal arch level, with fewer adverse aortic events during the follow-up period with acceptable early outcomes; however, these findings are exploratory and require investigation.


Subject(s)
Aorta, Thoracic/surgery , Aortic Aneurysm, Thoracic/surgery , Aortic Dissection/surgery , Blood Vessel Prosthesis Implantation/methods , Aortic Dissection/diagnosis , Aorta, Thoracic/diagnostic imaging , Aortic Aneurysm, Thoracic/diagnosis , Female , Humans , Male , Middle Aged , Postoperative Period , Replantation , Retrospective Studies , Tomography, X-Ray Computed
9.
J Cardiothorac Surg ; 15(1): 312, 2020 Oct 12.
Article in English | MEDLINE | ID: mdl-33046087

ABSTRACT

BACKGROUND: Annular dilation by left atrial remodeling is considered the main cause of atrial function mitral regurgitation. Although acceptable outcomes have been obtained using mitral ring annuloplasty alone for atrial functional mitral regurgitation, data assessing outcomes of this procedure are limited. Therefore, we aimed to assess midterm outcomes of mitral valve repair in patients with atrial functional mitral regurgitation. METHODS: We retrospectively studied 40 patients (mean age: 69 ± 9 years) who had atrial fibrillation that persisted for > 1 year, preserved left ventricular ejection fraction of > 40%, and mitral valve repair for atrial functional mitral regurgitation. The mean clinical follow-up duration was 42 ± 24 months. RESULTS: Mitral ring annuloplasty was performed for all patients. Additional repair including anterior mitral leaflet neochordoplasty was performed for 22 patients. Concomitant procedures included maze procedure in 20 patients and tricuspid ring annuloplasty in 31 patients. Follow-up echocardiography showed significant decreases in left atrial dimensions and left ventricular end-diastolic dimensions. Recurrent mitral regurgitation due to ring detachment or leaflet tethering was observed in five patients and was seen more frequently among those with preoperative left ventricular dilatation. Three patients without tricuspid ring annuloplasty or sinus rhythm recovery by maze procedure developed significant tricuspid regurgitation. Five patients who underwent the maze procedure showed sinus rhythm recovery. Rates of freedom from re-admission for heart failure at 1 and 5 years after surgery were 95 and 86%, respectively. CONCLUSIONS: Mitral valve repair is not sufficient to prevent recurrent atrial functional mitral regurgitation in patients with preoperative left ventricular dilatation. Tricuspid ring annuloplasty may be required for long-term prevention of significant tricuspid regurgitation.


Subject(s)
Atrial Fibrillation/surgery , Heart Failure/etiology , Mitral Valve Insufficiency/surgery , Aged , Atrial Fibrillation/complications , Atrial Fibrillation/diagnostic imaging , Echocardiography , Female , Heart Valve Prosthesis Implantation , Humans , Male , Mitral Valve Insufficiency/complications , Mitral Valve Insufficiency/diagnostic imaging , Postoperative Complications/etiology , Retrospective Studies , Treatment Outcome
10.
Clin Case Rep ; 8(9): 1663-1665, 2020 Sep.
Article in English | MEDLINE | ID: mdl-32983472

ABSTRACT

Current evidence suggests that the choice between valve-in-valve transcatheter aortic valve implantation and reoperative aortic valve replacement should be based on multiple factors.

11.
Ann Thorac Surg ; 109(1): 86-92, 2020 01.
Article in English | MEDLINE | ID: mdl-31336064

ABSTRACT

BACKGROUND: The Trifecta valve (Abbott, St Paul, MN) has excellent hemodynamic performance with acceptable rates of freedom from structural valve degeneration. However, some recent studies have reported early Trifecta valve failure. Here, we report a case series of seven Trifecta valve failures with a review of the literature. METHODS: Of 107 implantations of Trifecta bioprostheses between 2012 and 2014, we encountered seven Trifecta valve failures (6.5%). Failure of a 19-mm Trifecta valve occurred in 1 patient, failure of a 21-mm Trifecta valve occurred in 5 patients, and failure of a 23-mm Trifecta valve occurred in 1 patient. The mean duration of valve durability was 51 ± 16 months. The mean effective orifice area index on the first echocardiogram after Trifecta valve implantation was 0.96 ± 0.26. The mode of presentation was prosthetic valve stenosis in 3 patients and severe aortic regurgitation in 4 patients. RESULTS: Six patients underwent redo surgical aortic valve replacement. The common pathologic findings were circumferential pannus formation with noncoronary cusp tear and leaflet calcification. The rates of preoperative end-renal stage disease and postoperative prosthesis-patient mismatch were higher in patients with Trifecta valve failure. The incidence of early Trifecta valve failure was 3.1% at 48 months and 13.1% at 72 months. CONCLUSIONS: In our experience, early Trifecta valve failure was caused by cusp tears or leaflet calcification. Patients with end-renal stage disease and prosthesis-patient mismatch should be closely followed. Some patients with cusp tears may require urgent surgery.


Subject(s)
Aortic Valve Insufficiency/surgery , Aortic Valve Stenosis/surgery , Bioprosthesis , Heart Valve Prosthesis , Postoperative Complications/surgery , Prosthesis Failure , Aged , Female , Heart Valve Prosthesis Implantation , Humans , Male , Middle Aged , Prosthesis Design , Retrospective Studies
12.
J Cardiothorac Surg ; 14(1): 205, 2019 Nov 27.
Article in English | MEDLINE | ID: mdl-31775821

ABSTRACT

BACKGROUND: Good mid-term durability of mitral valve repair of bileaflet lesions has been reported; however, patients may develop failure during follow-up. This study assessed late outcomes and mechanisms of failure associated with mitral valve repair of bileaflet lesions. METHODS: Fifty-six patients (mean age 67 ± 12 years) underwent mitral valve repair of bileaflet lesions due to degenerative disease in 2011-2018. Mitral annuloplasty was added to all procedures except for 1 patient with annular calcification. Mitral valve lesions were identified by surgical inspection. Mean clinical and echocardiography follow-up occurred at 2.7 ± 2.1 and 2.5 ± 1.9 years, respectively. RESULTS: Additional mitral valve repair techniques involved triangular resection (n = 15 patients), quadrangular resection with sliding plasty (n = 12), neochordoplasty (n = 52), and commissural plication (n = 26). Prolapse of ≥2 anterior and posterior leaflet scallops occurred in 22 (39%) and 30 (54%) patients, respectively. During follow-up, 10 (17.8%) patients developed moderate or severe mitral regurgitation. Whereas prolapse or tethering was observed early after neochordoplasty or quadrangular resection, recurrent regurgitation occurred late after commissural repair. Five-year freedom from recurrent moderate or severe mitral regurgitation rates was 71.1 ± 11.0%. CONCLUSIONS: Seventeen percent of patients developed recurrent mitral regurgitation during follow-up. Repair failure in the early phase occurred owing to aggressive resection of the posterior mitral leaflet or maladjustment of the artificial neochordae. Recurrent mitral regurgitation might occur in the late phase even after acceptable commissural repair. A sequential approach may be useful to improve the quality of mitral valve repair in bileaflet lesions.


Subject(s)
Mitral Valve Annuloplasty , Mitral Valve Insufficiency/surgery , Mitral Valve Prolapse/surgery , Mitral Valve/surgery , Adult , Aged , Aged, 80 and over , Echocardiography , Female , Follow-Up Studies , Humans , Male , Middle Aged , Mitral Valve/pathology , Mitral Valve Insufficiency/diagnosis , Mitral Valve Insufficiency/pathology , Mitral Valve Prolapse/diagnosis , Mitral Valve Prolapse/pathology , Recurrence , Treatment Outcome
13.
Innovations (Phila) ; 14(6): 537-544, 2019.
Article in English | MEDLINE | ID: mdl-31619102

ABSTRACT

OBJECTIVE: To delineate the efficacy and safety of transthoracic cannulation to the ascending aorta through a right pleural cavity during minimally invasive cardiac surgery (MICS). METHODS: We retrospectively assessed the records of 104 patients who underwent MICS in our institution between December 2011 and December 2018. Procedures included mitral valve repair (88 patients), aortic valve replacement (8 patients), atrial septal defect closure (6 patients), and myxoma resection (2 patients). Aortic valve replacements were performed through the third intercostal space (ICS), whereas the other procedures were mainly performed through the fourth ICS. The femoral group comprised 60 patients in whom an artificial graft was anastomosed to the femoral artery and 4 who underwent cannulation into the femoral artery. The aorta group comprised 40 patients in whom transthoracic cannulation was performed through the second or third ICS, separate from the main skin incision. RESULTS: No mortality or critical complications were associated with cardiopulmonary bypass. Perfusion pressure measured at outflow of the artificial lung (224 ± 43 vs. 190 ± 42; P < 0.001) and pump pressure measured at the outflow of the pump (293 ± 50 vs. 255 ± 57; P < 0.001) were significantly higher in the femoral group than in the aorta group. The skin incision lengths were similar (56.9 ± 6.9 vs. 55.1 ± 6.0 mm; P = 0.107). CONCLUSIONS: Transthoracic cannulation into the ascending aorta is reliable and can be safely performed. The possible risks associated with peripheral cannulation and retrograde perfusion can be avoided thereafter.


Subject(s)
Aorta/surgery , Cardiac Surgical Procedures/instrumentation , Catheterization/methods , Femoral Artery/surgery , Minimally Invasive Surgical Procedures/methods , Aged , Cardiopulmonary Bypass/methods , Cardiopulmonary Bypass/statistics & numerical data , Catheterization/adverse effects , Female , Heart Atria/surgery , Heart Neoplasms/surgery , Heart Septal Defects, Atrial/surgery , Heart Valve Prosthesis/adverse effects , Heart Valves/surgery , Humans , Male , Middle Aged , Myxoma/surgery , Perfusion/methods , Perfusion/trends , Pressure/adverse effects , Retrospective Studies , Safety , Surgical Wound/epidemiology , Treatment Outcome
14.
Transplant Proc ; 51(9): 3174-3177, 2019 Nov.
Article in English | MEDLINE | ID: mdl-31619345

ABSTRACT

A 19-year-old Asian woman presented to the emergency department with ventricular fibrillation. Emergent coronary angiography revealed a 99% ostial stenosis of the left main coronary trunk, and percutaneous coronary intervention was performed. Takayasu arteritis was suspected, but fluorodeoxyglucose positron emission tomography scanning showed no active inflammation. Cardiac function was affected by ischemic cardiomyopathy, and an extracorporeal left ventricular assisted device was implanted under INTERMACS profile 1 status. Histopathology of the ascending aortic wall at the outflow anastomosis site showed no significant sign of Takayasu arteritis. The absence of systemic inflammation led to the replacement of the extracorporeal left ventricular assisted device with a Jervik 2000 as a bridge to transplant. An orthotropic heart transplant took place after a 39-month wait. Histopathology of the explanted heart revealed intimal and adventitial thickening with destruction of the elastic lamina localized at the sinus of Valsalva. Our final pathologic diagnosis was localized Takayasu arteritis. To counter the increased risk of stenosis or pseudoaneurysm formation at the vascular anastomosis site, anti-inflammatory therapy was essential in Takayasu arteritis. The post-heart transplant immunosuppression regime was considered stronger than that for Takayasu arteritis, and we therefore administered prednisolone, mycophenolate mofetil, and tacrolimus as standard protocol. There have been no signs of either relapse or rejection of transplantation for over 1 year. Further closed observation is required to clarify the long-term outcome of this rare condition with regard to heart transplantation.


Subject(s)
Cardiomyopathies/etiology , Cardiomyopathies/surgery , Heart Transplantation , Sinus of Valsalva/pathology , Takayasu Arteritis/complications , Takayasu Arteritis/pathology , Female , Heart-Assist Devices , Humans , Myocardial Ischemia/etiology , Myocardial Ischemia/surgery , Young Adult
15.
Ann Thorac Surg ; 108(3): e157-e159, 2019 Sep.
Article in English | MEDLINE | ID: mdl-30853590

ABSTRACT

Methotrexate has been reported as an immunosuppressive agent associated with lymphoproliferative disorders. This report describes the case of a cardiac methotrexate-induced lymphoproliferative disorder that could be differentiated from a sinus of Valsalva aneurysm rupture by cardiac magnetic resonance imaging and fluorine-18 (18F)-fluorodeoxyglucose positron emission tomography combined with computed tomography. The definitive diagnosis was made by a tissue biopsy that was concomitantly performed with sinus of Valsalva aneurysm repair. Significant regression was seen in response to methotrexate withdrawal. To the best of our knowledge, this is the first case of a cardiac methotrexate-induced lymphoproliferative disorder.


Subject(s)
Heart Aneurysm/surgery , Heart Neoplasms/surgery , Lymphoproliferative Disorders/chemically induced , Lymphoproliferative Disorders/surgery , Methotrexate/adverse effects , Sinus of Valsalva/pathology , Aneurysm, Ruptured/diagnostic imaging , Aneurysm, Ruptured/surgery , Arthritis, Rheumatoid/diagnosis , Arthritis, Rheumatoid/drug therapy , Biopsy, Needle , Cardiac Surgical Procedures/methods , Diagnosis, Differential , Female , Follow-Up Studies , Heart Aneurysm/diagnostic imaging , Heart Neoplasms/diagnostic imaging , Humans , Immunohistochemistry , Lymphoproliferative Disorders/diagnostic imaging , Magnetic Resonance Imaging, Cine/methods , Methotrexate/therapeutic use , Middle Aged , Multimodal Imaging/methods , Positron Emission Tomography Computed Tomography/methods , Rare Diseases , Sinus of Valsalva/surgery , Treatment Outcome
16.
Article in English | MEDLINE | ID: mdl-30753390

ABSTRACT

OBJECTIVES: Endovascular repair has been proposed as an alternative to classical surgical repair for the management of blunt traumatic thoracic aortic injury. However, the long-term outcomes of endovascular repair and the risks of left subclavian coverage remain unclear. METHODS: From April 2001 to August 2018, 33 patients with blunt traumatic thoracic aortic injury underwent endovascular repair in our institution. A follow-up computed tomography and a clinical examination were performed before discharge and at 1 month, and yearly or every 2 years thereafter. RESULTS: The mean age was 45 ± 19 years. The technical success rate was 100%. Complete coverage of the left subclavian artery (LSCA) was performed in 20 patients (60.6%). Among 20 patients with coverage of the LSCA, revascularization was performed in 1 patient. No in-hospital deaths occurred. The clinical follow-up rate was 97%, with a mean period of 7 years and a maximum of 18 years. The survival rates were 100% at 1 year, 95% at 5 years and 88.7% at 10 years after the event. Among the 5 patients (20%) who developed neurological complications, 1 who had undergone implantation of a 200-mm long stent graft and LSCA coverage without revascularization developed paraplegia during the long-term follow-up. CONCLUSIONS: This study demonstrates that the endovascular treatment of blunt traumatic thoracic aortic injury is a safe and effective therapeutic method over a long-term follow-up period. LSCA coverage and long stent graft placement might be indications for revascularization to prevent spinal cord injury.

17.
Gen Thorac Cardiovasc Surg ; 67(8): 655-660, 2019 Aug.
Article in English | MEDLINE | ID: mdl-30737658

ABSTRACT

OBJECTIVES: We investigated current mechanisms causing low graft flow (LGF) following coronary artery bypass grafting, particularly for the right coronary artery (RCA). METHODS: We retrospectively assessed 230 individual bypass grafts as the sole bypass graft for the RCA using preoperative and postoperative quantitative angiography. Overall, 155 in-situ gastroepiploic arteries (GEAs) and 75 saphenous vein grafts (SVGs) were included. The size and status of the revascularised area were examined to determine whether these factors were associated with LGF (defined as ≤ 20 mL/min with intraoperative flowmetry). A distal lesion was defined as stenosis at segment #4, whereas a proximal lesion was stenosis at #1, #2 and #3. RESULTS: Graft flow in the SVG and the GEA for distal lesion was significantly less compared with that for proximal lesion (34 ± 26 vs. 60 ± 46, p < 0.0001 and 22 ± 12 vs. 43 ± 28, p = 0.0004, respectively). For proximal lesion, LGF was significantly more frequent when the minimal luminal diameter was over 1.27 compared with when it was less than 1.27 (p = 0.02). Prior myocardial infarction significantly correlated with LGF in the GEA (p = 0.007) and the SVG (p = 0.03). In 55 bypass grafts with LGF, the causes were competitive flow in 20.0%, small revascularised area in 38.1% and prior myocardial infarction in 32.7%. CONCLUSIONS: Along with the current strategy based on the severity of native coronary stenosis, the incidence of competitive flow decreased remarkably. This resulted in flow demand, myocardial status and collateral vessels more influential on graft patency.


Subject(s)
Coronary Artery Bypass , Coronary Stenosis/surgery , Coronary Vessels/physiology , Gastroepiploic Artery/transplantation , Saphenous Vein/transplantation , Aged , Blood Flow Velocity/physiology , Blood Vessel Prosthesis , Coronary Angiography/methods , Coronary Stenosis/physiopathology , Coronary Vessels/surgery , Female , Humans , Male , Middle Aged , Myocardial Infarction , Myocardium , Postoperative Period , Regional Blood Flow/physiology , Retrospective Studies , Vascular Patency
18.
Ann Thorac Surg ; 107(6): 1914, 2019 06.
Article in English | MEDLINE | ID: mdl-30771320
19.
Ann Thorac Surg ; 107(4): e263-e265, 2019 04.
Article in English | MEDLINE | ID: mdl-30359591

ABSTRACT

The surgical indication and optimal approach for ischemic mitral regurgitation with ventricular septal defect remain uncertain. Very few studies have reported the occurrence of left ventricular aneurysms after repair of ischemic ventricular septal defects. We report a case of a left posterior ventricular aneurysm that developed after an urgent operation to repair an acute ischemic posterior ventricular septal defect using the double-patch sandwich technique via a right ventriculotomy.


Subject(s)
Cardiac Surgical Procedures/adverse effects , Heart Aneurysm/etiology , Heart Septal Defects, Ventricular/etiology , Heart Septal Defects, Ventricular/surgery , Inferior Wall Myocardial Infarction/complications , Acute Disease , Aged , Cardiac Surgical Procedures/methods , Coronary Stenosis/complications , Coronary Stenosis/diagnostic imaging , Echocardiography/methods , Female , Follow-Up Studies , Heart Aneurysm/diagnostic imaging , Heart Aneurysm/surgery , Heart Ventricles/surgery , Humans , Inferior Wall Myocardial Infarction/diagnostic imaging , Monitoring, Intraoperative/methods , Risk Assessment , Time Factors , Treatment Outcome , Ultrasonography, Doppler, Color/methods
20.
J Cardiothorac Surg ; 13(1): 121, 2018 Nov 22.
Article in English | MEDLINE | ID: mdl-30466471

ABSTRACT

BACKGROUND: The aim of this study was to delineate impacts of percutaneous coronary intervention (PCI), flow demand, and status of myocardium on graft flow. METHODS: We retrospectively assessed 736 individual coronary artery bypass grafts that had been created as the sole bypass graft for a vascular region in 405 patients. The grafts comprised 334 internal thoracic artery (ITA) to left anterior descending (LAD), 129 ITA and 65 saphenous vein grafts (SVG) to left circumflex (LCX), and 142 gastroepiploic artery (GEA) and 66 SVG to right coronary artery (RCA). Minimal luminal diameter, size of revascularized area, history of myocardial infarction, and PCI in the relevant area were examined to determine whether these factors are associated with flow insufficiency (FI), which was defined as ≤ 20 mL/min. RESULTS: FI developed in 123/736 grafts (16.7%) and correlated significantly with stenosis in the distal portion (23.0% vs. 12.8%, p = 0.0003). Prior myocardial infarction significantly correlated with FI in GEA-RCA (p = 0.002) and ITA-LCX grafts (p = 0.04). There was a history of PCI to the LAD (PCI group) in 54 ITA to LAD bypass grafts (16.2%), whereas the remaining 280 had no history of PCI to the LAD (no-PCI group). Graft flow was significantly greater in the no-PCI than in the PCI group (53 ± 29 vs. 42 ± 27; p = 0.006). The incidences of FI and graft failure were significantly higher in the PCI than the no-PCI group (22.2%, vs. 8.2%; p = 0.003; 9.2% vs. 1.8%; p = 0.003, respectively). CONCLUSIONS: Prior PCI has a negative impact on graft flow. The influences of small revascularized area, myocardial infarction, and PCI are greater, necessitating consideration of factors associated with flow demand or microvasculature when planning revascularization.


Subject(s)
Coronary Restenosis/diagnostic imaging , Graft Occlusion, Vascular/diagnostic imaging , Vascular Patency , Aged , Coronary Angiography , Coronary Artery Bypass , Coronary Restenosis/physiopathology , Coronary Restenosis/prevention & control , Female , Graft Occlusion, Vascular/physiopathology , Graft Occlusion, Vascular/prevention & control , Humans , Intraoperative Care , Male , Myocardial Infarction/surgery , Percutaneous Coronary Intervention , Retrospective Studies , Rheology
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