Long-term results of triple valve repair in rheumatic heart disease.

BACKGROUND: The aim of this study is to analyze the clinical outcomes of triple valve repair for rheumatic heart disease in terms of both early results and long-term benefits. METHODS: Between January 2008 and December 2016, all the patients who underwent triple valve repair for rheumatic heart disease were included in this study. RESULTS: Thirty-eight patients underwent triple valve repair procedure for rheumatic heart disease at our institute. Mean age was 33 years; 60.5% were females. Techniques used to achieve mitral valve repair were: commisurotomy (n = 26), prosthetic ring annuloplasty (n = 9), posterior teflon annuloplasty (n = 23), leaflet shaving (n = 14), implantation of neochordae (n = 5) and pericardial patch augmentation of mitral valve leaflets (n = 6). For aortic valve repair, the techniques used were: commisurotomy (n = 23), leaflet shaving (n = 16), pericardial patch augmentation (n = 3), subcommisural plication (n = 10), free margin plication (n = 2) and free margin resuspension (n = 1). Tricuspid valve repair was performed using modified Devega's technique (n = 32), commisurotomy (n = 9) and posterior annular plication (bicuspidization) (n = 5). The operative mortality was 0%. There was no primary repair failure. Estimated survival at the end of 1 year, 5 years and 10 years was 100%, 91.6% and 65.8%, respectively. Overall freedom from reintervention at 1, 5 and 10 years was 100%, 96.4% and 61.4, respectively. CONCLUSION: Triple valve repair provided satisfactory early and long-term results in this challenging subset of patients and can be considered as an acceptable option for significant triple valve disease due to the absence of anticoagulation-related events.

Improvements in left ventricular twist mechanics following myectomy for hypertrophic cardiomyopathy with mid-ventricular obstruction.

We aimed to evaluate left ventricle twist mechanics in mid-ventricular obstructive and apical type of hypertrophic cardiomyopathy and changes induced by myectomy. We studied 3 consecutive patients by cardiac magnetic resonance preoperatively and 6 weeks after myectomy. We calculated the apical and basal rotations at the base and apex respectively. All 3 patients underwent myectomy by the standard described technique. The basal rotations remained the same, while there was an improvement in the maximal apical rotation from 0.385 ± 0.3975° to 0.9086 ± 1.1751°. In hypertrophic cardiomyopathy with mid-ventricular obstruction and apical hypertrophy, there is decreased apical rotation, which improves after myectomy.

Restoration of optimal ellipsoid left ventricular geometry: lessons learnt from in silico surgical modelling.

OBJECTIVES: Several issues that are inherent in the surgical techniques of surgical ventricular restoration (SVR) need specialized devices or techniques to overcome them, which may not always result in optimal outcomes. We used a non-invasive novel in silico modelling technique to study left ventricular (LV) morphology and function before and after SVR. The cardiac magnetic resonance imaging derived actual pre- and postoperative endocardial morphology and function was compared with the in silico analysis of the same. METHODS: Cardiac magnetic resonance steady state free precession (SSFP) cine images were employed to segment endocardial surface contours over the cardiac cycle. Using the principle of Hausdorff distance to examine phase-to-phase regional endocardial displacement, dyskinetic/akinetic areas were identified at the instant of peak basal contraction velocity. Using a three-dimensional (3D) surface clipping tool, the maximally scarred, dyskinetic or akinetic LV antero-apical areas were virtually resected and a new apex was created. A virtual rectangular patch was created upon the clipped surface LV model by 3D Delaunay triangulation. Presurgical endocardial mechanical function quantified from cine cardiac magnetic resonance, using a technique of spherical harmonics (SPHARM) surface parameterization, was applied onto the virtually clipped and patched LV surface model. Finally, the in silico model of post-SVR LV shape was analysed for quantification of regional left ventricular volumes (RLVVs) and function. This was tested in 2 patients with post-myocardial infarction antero-apical LV aneuryms. Left ventricular mechanical dysynchrony was evaluated by RLVV analysis of pre-SVR, in silico post-SVR and actual post-SVR LV endocardial surface data. RESULTS: Following exclusion of the scarred areas, the virtual resected LV model demonstrated significantly lesser areas of akinesia. The decreases in regional LV volumes in the in silico modelling were significant and comparable with the actual decreases following SVR. Both the regional end diastolic volume (EDV) and end systolic volume (ESV) at the apex decreased significantly corresponding to greater reductions in apical volumes by the technique of rectangular patch plasty (apical EDV 2.1607 ± 0.20577 to 0.4774 ± 0.1775 ml, P = 0.007; apical ESV 1.9708 ± 0.36451 to 0.442 ± 0.047 ml, P = 0.013). CONCLUSIONS: This pilot study was done using novel in silico techniques for virtual surgical modelling, which helped in accurate estimation and planning of optimal LV restoration by SVR.

Distal carotid perfusion in combined carotid endarterectomy and OP-CABG.

An alternative method of maintaining carotid perfusion during combined carotid endarterectomy and off-pump coronary artery bypass grafting involves insertion of a cannula in the ascending aorta after a median sternotomy. This cannula is connected to a perfusion cannula, the distal end of which is inserted into the carotid artery beyond the carotid arteriotomy. This technique of aortico-carotid shunting and carotid perfusion was utilized in nine patients who underwent successful combined carotid endarterectomy and off-pump coronary artery bypass grafting.

Programa de recuperación rápida (Fast Track) en la cirugía de revascularización miocárdica: análisis de sus implicancias médicas y económicas / Fast track program for recovery from coronary artery surgery: medical and economic implications

El programa de recuperación rápida (Fast Track) consiste en una serie de intervenciones perioperatorias que les permite a los pacientes sometidos a cirugía de revascularización miocárdica recuperar el nivel de salud y actividad más rápido y con mejor expectativa de vida. Ciento dos pacientes sometidos a cirugía de revascularización miocárdica fueron enrolados en el Fast Track. Resultados: el 63 por ciento de los pacientes fue dado de alta en el quinto día posoperatorio o antes. No hubo mortalidad asociada con el Fast Track y la única reinternación (1 por ciento) no estuvo relacionada con el programa. Se concluye que el Fast Track es efectivo y seguro (AU)

Programa de recuperación rápida (Fast Track) en la cirugía de revascularización miocárdica: análisis de sus implicancias médicas y económicas / Fast track program for recovery from coronary artery surgery: medical and economic implications

El programa de recuperación rápida (Fast Track) consiste en una serie de intervenciones perioperatorias que les permite a los pacientes sometidos a cirugía de revascularización miocárdica recuperar el nivel de salud y actividad más rápido y con mejor expectativa de vida. Ciento dos pacientes sometidos a cirugía de revascularización miocárdica fueron enrolados en el Fast Track. Resultados: el 63 por ciento de los pacientes fue dado de alta en el quinto día posoperatorio o antes. No hubo mortalidad asociada con el Fast Track y la única reinternación (1 por ciento) no estuvo relacionada con el programa. Se concluye que el Fast Track es efectivo y seguro