Prosthetic valve selection for middle-aged patients with aortic stenosis.

Choosing the optimal aortic valve prosthesis for middle-aged patients (late 40s to early 60s) with aortic stenosis presents a challenge. The available options all have substantial drawbacks that must be considered in the decision-making process. Current data indicate that there is little or no difference in survival between mechanical and bioprosthetic aortic valve replacement in middle-aged patients at 10-15 years after surgery.

A propensity score-adjusted retrospective comparison of early and mid-term results of mitral valve repair versus replacement in octogenarians.

Aims: Feasibility and efficacy of mitral repair in the elderly remain controversial. This study aims to compare outcomes of mitral repair and replacement in octogenarians.

Methods And Results: We compared the outcomes of 322 consecutive octogenarian patients (mean age 82.

Surgical strategies for functional tricuspid regurgitation.

Functional or secondary tricuspid regurgitation commonly is found in the setting of left-sided heart disease and, when severe, is associated with substantially poorer functional outcomes and survival if untreated. The traditional view that functional tricuspid regurgitation generally resolves with surgical correction of the primary lesions is no longer held. Data showing late development of severe tricuspid regurgitation in patients with mild regurgitation at time of mitral valve surgery have heralded a new era of aggressive intervention on the tricuspid valve.

Current diagnosis and management of left main coronary disease.

Left main coronary artery (LMCA) disease remains an important risk factor for increased mortality and morbidity at all stages of diagnosis and treatment of coronary artery disease. Left main stem pathology is often silent, with unpredictable presentation: as such it poses diagnostic and management challenges. This article reviews the anatomy, epidemiology and diagnosis of left main stem disease, as well as advances in multidisciplinary concepts of diagnosis and management, and summarises the outcomes of recent prospective studies comparing percutaneous and surgical revascularisation in LMCA disease.

The impact of moderate-to-end-stage renal failure on outcomes after coronary artery bypass graft surgery.

Objectives: Currently, established renal failure is a well-recognized risk factor for operative mortality in patients undergoing coronary artery bypass graft (CABG) surgery. The authors aimed to establish the relative impact of dialysis-dependent renal failure (DRF) and nondialysis-dependent renal failure (NDRF) on early and late outcome after CABG surgery.

Design: A retrospective cohort study.

Modified Cabrol shunt to treat left ventricular rupture.

Left ventricular rupture is a rare but potentially fatal complication of mitral valve replacement. We describe how a modified Cabrol shunt was used to address intractable hemorrhage from a left ventricular rupture after reoperative mitral valve replacement.

Comparison of the results of aortic valve replacement with or without concomitant coronary artery bypass grafting in patients with left ventricular ejection fraction < or =30% versus patients with ejection fraction >30%.

The present study was designed to test the hypothesis that low-ejection fraction (EF), low-gradient aortic stenosis (AS) is a predictor of major morbidity after aortic valve replacement (AVR). We retrospectively analyzed prospectively collected data from 597 consecutive patients with AS (mean age 72 +/- 11 years) who had undergone AVR or combined AVR and coronary artery bypass grafting (CABG) from 1998 to 2006 (EF < or =30% in 73 [12%]). The outcome measures included hospital mortality, major complications, and long-term survival.

Current concepts in ablation of atrial fibrillation.

Atrial fibrillation (AF) is the most common arrhythmia in clinical practice. It occurs particularly frequently in cardiac surgical patients and is associated with significant excess mortality and morbidity. Pharmacological management of AF is relatively ineffective and associated with significant side effects and complications.

State of the art: degenerative mitral valve disease.

Mitral valve repair offers superior long-term survival, freedom from cardiac morbidity, and quality of life in patients with severe mitral regurgitation compared to medical management and mitral valve replacement; it is the treatment of choice in these patients. Mitral valve repair is the only treatment that restores normal life expectancy to otherwise healthy patients with advanced degenerative mitral valve disease. This review focuses on indications, timing and techniques for mitral valve repair in degenerative disease, emphasising the importance of anatomy in surgical outcomes.

Predicting postoperative renal failure requiring dialysis, and an analysis of long-term outcome in patients undergoing valve surgery.

Background And Aim Of The Study: Previous studies have been unable to identify independent valve-related risk factors for the occurrence of renal failure requiring dialysis (RF-D) in patients undergoing valve surgery. The study aim was to determine the incidence and predictors of renal failure in these patients, and to create a model based on these risk factors that could serve as a tool to predict this complication.

Methods: Between January 1998 and December 2006, a total of 2,690 consecutive patients (1,546 males, 1,144 females; mean age 64 +/- 15 years) underwent valve or combined valve/coronary artery bypass graft (CABG) surgery at the authors' institution.

Cardiac anesthesia and surgery in geriatric patients: epidemiology, current surgical outcomes, and future directions.

The mean life expectancy of the population of the United States is projected to increase from 78.3 years at present to over 81 years in 2025, with a concomitant increase in the percentage of the population over the age of 75 years. Elderly patients are more likely to present with valvular and coronary artery disease than younger patients, and as better perioperative management contributes to improving post-operative outcomes and lower referral thresholds, very elderly patients form an increasingly large proportion of the cardiac surgical population.

Logistic risk model predicting postoperative respiratory failure in patients undergoing valve surgery.

Background: Previous studies have been unable to identify independent valve-related risk factors for postoperative respiratory failure (RF) in patients undergoing valve surgery. This study was designed to determine the incidence and predictors of RF in these patients. We also aimed to create a model based on these risk factors that could serve as a tool for the prediction of this complication.

Off-pump coronary artery bypass surgery may reduce the incidence of stroke in patients with significant left main stem disease.

Background: Off-pump coronary artery bypass (OPCAB) surgery in patients with left main stem (LMS) disease remains controversial. This meta-analysis compares early outcomes of OPCAB surgery with on-pump coronary artery bypass (ONCAB) surgery in patients with significant LMS disease, focusing on the outcomes stroke and transient ischemic attack (TIA).

Methods: This is a meta-analysis of non-randomized comparative peer-reviewed publications sourced from a systematic search of Embase, Medline, Cochrane, Google Scholar and CINAHL (1965-2007).

Prosthesis type has minimal impact on survival after valve surgery in patients with moderate to end-stage renal failure.

Background: Few previous studies have reported on the outcome of patients with renal failure (RF) undergoing valvular surgery, particularly with regard to choice of valve prosthesis.

Methods: We retrospectively analyzed prospectively collected data from 155 patients with RF (mean age 62 +/- 14, 42% female) who underwent left-sided valve surgery from January 1998 to December 2006. Patients were divided into two groups: Group 1 (non-dialysis-dependent renal failure (NDRF); creatinine >2.

Tricuspid valve repair for treatment and prevention of secondary tricuspid regurgitation in patients undergoing mitral valve surgery.

Secondary or functional tricuspid regurgitation occurring late after mitral valve surgery is associated with high morbidity and mortality. In this article, we review the pathophysiology of secondary tricuspid regurgitation and the evidence supporting the use of tricuspid valve annuloplasty for preventing and treating secondary tricuspid regurgitation. Liberal application of tricuspid valve annuloplasty is recommended to prevent progression of secondary regurgitation, as contrary to widely held opinion, fixing the left-sided valve dysfunction often does not resolve secondary tricuspid valve dysfunction.

Cardiac anesthesia and surgery in geriatric patients.

The average age of US population is steadily increasing, with more than 15 million people aged 80 and older. Coronary artery disease and degenerative cardiovascular diseases are particularly prevalent in this population. Consequently, an increasing number of elderly patients are referred for surgical intervention.

Predictors and early and late outcomes of respiratory failure in contemporary cardiac surgery.

Background: Respiratory failure (RF) is a serious complication following heart surgery. The profile of patients referred for cardiac surgery has changed during the last decade, making prior investigations of RF after cardiac surgery less relevant to the current population. This study was designed to analyze the incidence, predictors of RF, and early and late outcomes following this complication in a large contemporary cardiac surgery population.

Does previous percutaneous coronary stenting compromise the long-term efficacy of subsequent coronary artery bypass surgery? A microsimulation study.

Background: This study aims to compare long-term survival and health-related quality of life in patients undergoing coronary artery bypass surgery with and without previous coronary stenting.

Methods: Markov microsimulation was used to model long-term survival and quality of life after surgical revascularization using data from referenced sources. Probabilistic sensitivity analysis was used to investigate the effect of uncertainty associated with the model parameters on the microsimulation results.

Results and predictors of early and late outcomes of coronary artery bypass graft surgery in octogenarians.

Objectives: The aim of this study was to investigate early and late outcomes of coronary artery bypass graft (CABG) surgery in a large cohort of octogenarian patients. The results were compared with 2 other age groups including septuagenarians and patients <70 years old.

Design: A retrospective study of consecutive patients undergoing CABG surgery using a computerized database based on the New York State Department of Health registry.

Excellent early and late outcomes of aortic valve replacement in people aged 80 and older.

Objectives: To investigate early and late outcome of aortic valve replacement (AVR) in a large cohort of patients aged 80 and older.

Design: Retrospective study of consecutive patients undergoing AVR using a computerized database based on the New York State Department of Health registry. Data collection was performed prospectively.

Tracheostomy is not a risk factor for deep sternal wound infection after cardiac surgery.

Background: Previous studies on predictors of deep sternal wound infection (DSWI) have identified either respiratory failure or tracheostomy as a risk factor for the occurrence of this complication. This study was conducted to analyze the interaction between these two variables. We hypothesize that respiratory failure and not tracheostomy per se is associated with an increased risk of DSWI.

Impact of body mass index on early outcome and late survival in patients undergoing coronary artery bypass grafting or valve surgery or both.

The influence of body mass on outcome after cardiac surgery remains controversial. The aim of this study was to analyze the impact of body mass index (BMI) on early and late outcomes in a large series of patients who underwent cardiac surgery. We retrospectively analyzed 5,950 consecutive patients who underwent cardiac surgery between January 1998 and September 2006.