Minimally invasive versus conventional aortic valve replacement: a 10-year experience.

AIM: Data on the impact of minimally invasive approach on clinical outcomes after isolated aortic valve replacement (MIAVR) are limited and somewhat controversial. The aim of the study was to compare the outcomes of patients undergoing MIAVR and conventional aortic valve replacement (CAVR) in a large cohort of patients operated over a decade. METHODS: The study population consisted of 466 consecutive patients undergoing isolated AVR between 1995 and 2005. Outcomes of 164 patients undergoing MIAVR were compared to 302 patients undergoing CAVR. Univariable and multivariable analyses were performed to identify predictors of outcomes. RESULTS: Operative mortality and major complication rates were similar among the groups. Univariate analysis revealed that MIAVR was associated with reduced incidence of allogeneic blood transfusions (31% vs. 41%, P=0.03) and a shorter hospital stay (5+/-2 vs. 7+/-5 days, P<0.0001). In multivariable analysis, predictors for blood transfusions were age (OR=2.15), non elective operation (OR=1.36), female gender (OR=1.13), prolonged cardiopulmonary bypass time (OR=1.12) and CAVR (OR=2.57). Predictors of prolonged hospital stay were peripheral vascular disease (OR=4.83), diabetes mellitus (OR=3.2), aortic cross clamp time (OR=1.17), and CAVR (OR=4.46). CONCLUSION: MIAVR is a safe and effective procedure resulting in significant reduction of allogeneic blood transfusions and a shorter length of hospital stay.

N-terminal pro-B-type natriuretic peptide: reference plasma levels from birth to adolescence. Elevated levels at birth and in infants and children with heart diseases.

AIM: Determination of plasma levels of N-terminal pro-B-type natriuretic peptide (N-BNP) in infants and children with and without heart diseases. METHODS: Plasma N-BNP was measured in 78 infants and children without heart disease and in 55 infants and children with heart disease causing volume and pressure overload. Heart diseases included chronic dilated cardiomyopathy, acute left ventricular dysfunction, and congenital cardiac anomalies resulting in left and right ventricular volume or pressure overload. The Mann-Whitney rank-sum test and the ANOVA for ranks test were used to compare two or more groups, respectively. RESULTS: N-BNP levels were elevated in the first days of life but were not significantly different in children from 4 mo to 15 y old. The upper limit in children older than 4 mo with no heart disease was 349 pg/ml. In patients with heart disease, N-BNP levels were significantly higher than in control children (p < 0.0001). CONCLUSION: N-BNP levels are elevated in the first days of life and are stable from age 4 mo to adolescence. Elevated N-BNP levels reflect cardiac dysfunction in infants and children.

Lung cancer resection or aortic graft replacement with simultaneous myocardial revascularization without cardiopulmonary bypass.

BACKGROUND: The concomitant occurrence of lung cancer or other thoracic problems requiring surgical treatment in patients with significant coronary artery disease is uncommon. METHODS: Three patients underwent revascularization of the anterior descending artery, without cardiopulmonary bypass, with simultaneous pulmonary lobectomy (two patients) or replacement of an obstructed descending aortic graft (one patient). RESULTS: Postoperative ventilation time was < 3 h, and no morbidity related to the combined procedure occurred during midterm follow-up. CONCLUSIONS: This one-stage approach allowed the immediate solution of two intrathoracic comorbidities, reducing expenses and suffering to the patients and minimizing the risk of bleeding or tumor dissemination secondary to extracorporeal circulation-induced coagulopathy and immunosuppression.

[Concomitant surgery--coronary artery bypass and pulmonary lobectomy].

Coronary artery disease amenable to percutaneous interventions or coronary artery bypass grafting, and resectable lung cancer are major causes of morbidity and mortality. We present our experience in the treatment of 3 patients (men aged 64 and 66 and a woman of 77) who each had significant coronary artery disease and a resectable lung tumor. They underwent combined coronary artery bypass grafting and pulmonary lobectomy. We conclude from our experience and review of the literature that concomitant surgery in such cases is safe and effective, decreases suffering, and decreases the cost of 2 separate invasive procedures.