Direct aortic cannulation for port-access mitral or coronary artery bypass grafting.

A technique is described for direct aortic arterial cannulation during Port-Access mitral valve or coronary artery bypass grafting. Femoral arterial cannulation is avoided, and endoaortic balloon occlusion is used for cardioplegic arrest. To date, excellent results have been obtained in 45 patients.

Comparison of direct aortic and femoral cannulation for port-access cardiac operations.

Background: Differences in outcome after direct aortic cannulation (AORT) in the chest versus standard femoral arterial cannulation (FEM) have not been defined for minimally invasive cardiac operations utilizing the port-access approach.

Methods: A retrospective study was performed of 165 patients undergoing port-access cardiac mitral valve operation (n = 126) or coronary artery bypass grafting (n = 39). In 113 patients, FEM was used, while in 52 patients, AORT was accomplished through a port in the first intercostal space.

Mitral valve operation via Port Access versus median sternotomy.

Objective: The advantages and disadvantages of minimally invasive Port Access mitral valve operation have not been defined relative to standard median sternotomy. A study was therefore designed to delineate differences in outcome from mitral operation via Port Access versus sternotomy in comparable patients.

Methods: The records of 41 consecutive patients undergoing isolated mitral valve replacement (n = 14) or repair (n = 27) were examined.

Quantitative analysis of regional wall thickening by transesophageal echocardiography.

To develop a method for quantitative analysis of regional left ventricular function from transesophageal two-dimensional echocardiograms, we conducted studies 10 and 20 minutes after induction of anesthesia in 16 patients with normal hearts who were undergoing minor orthopedic operations. Wall thickening was measured with the centerwall method along 100 chords drawn perpendicular to a line constructed around the center of the ventricular wall, midway between the endocardial and epicardial contours. Thickening, either normalized by the length of the end-diastolic perimeter or expressed as a percentage of the end-diastolic wall thickness at each chord, was compared with measurements of endocardial motion.

Imaging of the coronary arteries by transesophageal echocardiography.

Detection of the proximal left and right coronary arteries is possible by transesophageal echocardiography with rather high frequencies. The proximal left coronary artery can be detected in 86% of patients and the proximal right in 82%. Precise identification of obstructive disease is possible but is confounded by heart movement and as yet inadequate criteria for its presence to make this routinely clinically possible.

Current management of mitral valve incompetence associated with coronary artery disease.

At a time when hospital mortality for adult cardiac operations is continuing to fall, the combined mitral valve coronary bypass subset remains at relatively high risk. Efforts to improve results should be directed toward a more general application of mitral reconstruction in this population, tailoring the type of repair to the pathological anatomy of valve dysfunction. Other promising therapeutic measures include the liberal use of reperfusion therapy in the acute papillary muscle dysfunction group, better selection patients for operation, and perhaps operative recommendation to a greater proportion of the more stable patients that previously were treated medically.