The preferable use of port access surgical technique for right and left atrial procedures.

We analyzed the results of mitral valve operations, either alone or in any combination with the tricuspid valve surgeries in the period from January 2001 till June 2004. The period was divided into two parts, classical sternotomy part (C) (110 patients) and minimally invasive port access part (PA) (105 patients), later being used from December 2002 till now. Also, what we were interested in was the total hospital cost of both types of the procedures and if there are any advantages of port access over the classical sternotomy. The mean age was 61.2 +/- 10.2 and 60.3 +/- 12.4 (C versus PA) and mean additive Euroscore was 6.5 versus 4.8 (C versus PA). There were statistically significant differences (P < .0001) in cardiopulmonary bypass time (CPB) and aortic cross-clamp time (AXT) between both groups: CPB C versus PA: 98.3 +/- 33.5 minutes versus 149.2 +/- 44.2 minutes (mean +/- sd), AXT C versus PA: 62.9 +/- 20.6 minutes versus 88.3 +/- 26.8 minutes (mean +/- sd). There were no statistically significant differences in mortality and stroke for both the groups (mortality P = 1, stroke P = .53). There were statistically significant differences in favor of the port access over the classical one for: intensive unit stay (P = .004), postoperative stay in days (P < .0001), blood transfusion (P < .0001), postoperative thoracic bleeding (P < .0001), and extubation time in hours (P < .0001). Furthermore, costs analyses showed that the average total patient cost was less for port access (P < .0005). The differences between endo and classical type suggested that the port access type of surgery is 20% cheaper than the classical one. We may conclude that port access surgery is an acceptable alternative to classical type of surgery, also in complex pathology of the mitral and tricuspid valve.

Imaging of power spectral heart rate variability regarding subject position.

Heart rate variability (HRV) and its assessment using power spectral analysis revealed a possibility to quantify the characteristics of autonomic nervous system, related cardiovascular status and sympathovagal interaction. This study was designed to assess vagal tone in supine and right recumbent position in normal healthy subjects as many maneuvers that potentially increase vagal tone have been sought both in normal subjects and in patients with heart disease. Seven subjects, four male and three female, aged 20-27 years were enrolled in the study. To evaluate the time-dependent stability of short term ECG recordings, every subject participated in six ECG recording sessions (three successive morning and three successive afternoon measurements). Heart rate power spectra were obtained by off-line Fast Fourier Transform analysis. The frequency domain measures, namely very low frequency power (VLF), low frequency power (LF), high frequency power (HF) and total power were determined, and their normalized correlates used in the comparison between supine and right recumbent position. Normalized high frequency (nHF) indicated cardiac vagal activity, normalized low frequency power indexed sympathetic modulated activity, low frequency power/high frequency power ratio (LF/HF) represented sympathovagal balance. The results showed remarkable variation among successive day measurements as well as among study subjects. However, several types of response to adopting right recumbent position could be identified. In the first, in right recumbent position the values of nHF, indicator of vagal activity did not differ appreciably from the values measured in supine position. Secondly, there was a tendency towards higher nHF values and lower LF/HF power ratio in supine position. We were not able to notice any appreciable difference among morning and afternoon short-term measurements. Finally, our results do not suggest higher vagal modulation when lying in right recumbent position.