Origins of Cardiovascular Surgery at the Mayo Clinic.

Sixty years ago, at the Mayo Clinic in Rochester, Minnesota, an ambitious group of pioneers, led by Dr John W. Kirklin and supported by a multidisciplinary team of physicians and technicians embarked on a planned series of surgical cases using a heart-lung machine to allow direct visualization of the inside of the opened human heart to repair otherwise fatal congenital intracardiac defects. Their success sparked the beginning of a new era of open-heart surgery.

Axillary arteriovenous fistula for the palliation of complex cyanotic congenital heart disease: is it an effective tool?

Objective: Patients with complex cyanotic congenital heart disease and a bidirectional cavopulmonary connection who are not candidates for or had failed Fontan operation may experience progressive cyanosis. An axillary arteriovenous anastomosis may be constructed to augment pulmonary blood flow. This report reviews our results with this approach in this complex group of patients.

Mitral annular growth in children following early mechanical mitral valve replacement.

Irreparable mitral pathology may lead to early mitral valve replacement (MVR) in children. Often, a small mechanical prosthesis (<23 mm) is required, raising concerns about annular growth in patients who may eventually require subsequent mitral valve re-replacement (MVRR). The aim of this study was to evaluate interval mitral annular growth in this cohort.

Reoperations after initial repair of complete atrioventricular septal defect.

Background: Excellent surgical results have been reported after repair of complete atrioventricular septal defects (CAVSD); however, 5% to 10% require reoperation. We examine causes leading to reoperation and evaluate long-term outcome.

Methods: Between 1972 and 2007, 50 patients (26 male) underwent reoperation at our institution after initial repair of CAVSD (median interval, 15 months; range, 3 days to 29 years).

Embolic potential of cardiac tumors and outcome after resection: a case-control study.

Background And Purpose: Embolic events have long been thought to occur in patients with cardiac tumors secondary to embolization of tumor fragments; however, there are no large studies examining the epidemiology and occurrence of embolism in this group of patients.

Methods: From 1957 to 2006, 323 consecutive patients with primary cardiac tumors were treated surgically at our institution. Of these, patients who experienced an embolic event included 80 (cerebrovascular accident 31 [9.

Survival after resection of primary cardiac tumors: a 48-year experience.

Background: Primary cardiac tumors are rare but have the potential to cause significant morbidity if not treated in an appropriate and timely manner. To date, however, there have been no studies examining survival characteristics of patients who undergo surgical resection.

Methods And Results: From 1957 to 2006, 323 consecutive patients underwent surgical resection of primary cardiac tumors; 163 (50%) with myxomas, 83 (26%) with papillary fibroelastomas, 18 (6%) with fibromas, 12 (4%) with lipomas, 28 (9%) with other benign primary cardiac tumors, and 19 (6%) with primary malignant tumors.

Endoluminal pulmonary artery banding: technique, applications and results.

Background: Occasionally pulmonary artery banding is necessary to reduce pulmonary arterial blood flow and pressure in patients who cannot be repaired in a single stage. Traditional extraluminal PAB can be associated with significant morbidity. We describe our technique, applications, and results of endoluminal pulmonary artery banding (EPAB) with and without creation of an aortopulmonary window (APW) for complex cardiac anomalies.

Mitral regurgitation surgery in heart failure due to ischemic cardiomyopathy: a 24-year experience.

Background And Aim Of The Study: The long-term benefits of mitral regurgitation (MR) surgery in ischemic cardiomyopathy (ICM) are controversial. Herein are reported the results and trends of this surgical approach over the past 24-year period.

Methods: Patients were identified in refractory heart failure due to ICM with NYHA functional class III/IV symptoms, left ventricular ejection fraction < or =35% and MR who underwent mitral surgery between 1979 and 2002.

Analysis of benign ventricular tumors: long-term outcome after resection.

Objective: We sought to compare clinical and pathologic characteristics of ventricular tumors and to detect whether differences exist in short- and long-term survival after resection.

Methods: From 1964 to 2005, 323 patients had cardiac surgery for resection of primary cardiac tumors; 53 (16%) patients had primary ventricular tumors. We randomly sampled 53 characteristics of ventricular tumors.

Intermediate-term results of ascending-descending posterior pericardial bypass of complex aortic coarctation.

Objective: Extra-anatomic bypass of complex thoracic aortic disease through a median sternotomy has been reported as a safe alternative to thoracotomy. Our objective was to examine intermediate-term outcomes.

Methods: We retrospectively reviewed 50 consecutive patients with congenital aortic coarctation or recurrent coarctation who underwent ascending-descending posterior pericardial aortic bypass between January 1985 and November 2005.

Results of the 1.5-ventricle repair for Ebstein anomaly and the failing right ventricle.

Objective: Repair of Ebstein anomaly and impaired right ventricular function pose challenges for the cardiac surgeon. The bidirectional cavopulmonary shunt may improve early outcomes. We reviewed our experience with the 1.

Cardiac surgery in patients with body mass index of 50 or greater.

Background: The seemingly inexorable rise in obesity worldwide is creating a new set of challenges for healthcare providers. Demand for cardiac surgical intervention among patients at extreme levels of obesity (body mass index [BMI] > or = 50) is increasing; however, the risks, benefits, and resources required to meet this need have not been established.

Methods: Between 1993 and 2004, 57 patients with a BMI of 50 or more underwent cardiac surgical procedures at our institution.

Early and late results of the modified fontan operation for heterotaxy syndrome 30 years of experience in 142 patients.

Objectives: We sought to evaluate the early and late results of the modified Fontan operation for patients with heterotaxy syndrome, assess variables traditionally known to correlate with poor outcome, and assess current health status of survivors after the Fontan procedure.

Background: The natural history of unoperated cardiac lesions in heterotaxy is known to be poor. Therefore, the Fontan operation has been proposed to improve survival.

Long-term results of the Konno procedure for complex left ventricular outflow tract obstruction.

Objective: This study was undertaken to determine long-term clinical and echocardiographic outcomes after the Konno procedure.

Methods: Fifty-three patients who underwent the Konno procedure between January 1, 1980, and January 1, 2004, were reviewed.

Results: Mean age at operation was 19 years (range, 1-65 years).

Giant coronary artery aneurysm causing superior vena cava syndrome and congestive heart failure.

Coronary artery aneurysms are defined as localized coronary artery dilations >1.5 times the diameter of the adjacent segments. In adults, they are commonly of atherosclerotic origin and are usually asymptomatic.

Thoracic aorta false aneurysm: what surgical strategy should be recommended?

Background: Thoracic aorta false aneurysms (TAFA) are a surgical challenge. The best technical approach remains uncertain.

Methods: Between 1981 and 2004, 57 patients underwent operation for TAFA (mean age 57 +/- 18 years; 43 [75%] were male).

The effect of adjuvant perfusion techniques on the incidence of paraplegia after repair of traumatic thoracic aortic transections.

Objective: To analyze the effect of adjuvant perfusion techniques of the distal aorta on the outcome of traumatic thoracic aortic transections.

Patients And Methods: From 1973 to 2004, 72 patients (mean age, 39 years) with thoracic aortic transections arrived alive at the emergency department. Nineteen patients arrived in extremis and underwent emergency operations, 42 patients were stable and underwent diagnostic evaluation before surgery (4 patients experienced aortic rupture during evaluation), and 11 patients presented more than 24 hours after the accident.

Right-sided Maze procedure for atrial tachyarrhythmias in congenital heart disease.

Background: Congenital heart disease (CHD) that causes right atrial dilatation is commonly associated with atrial flutter and/or fibrillation (AFl/F). To reduce late recurrence of AFl/F in patients undergoing repair of CHD, we utilized a concomitant right-sided maze procedure.

Methods: From 1993 to 2003, 99 patients with CHD and associated AFl/F underwent a concomitant right-sided maze procedure at the time of CHD repair.

Surgical treatment of cardiac papillary fibroelastoma: a single center experience with eighty-eight patients.

Background: Cardiac papillary fibroelastoma is a rare benign tumor that can cause thromboembolism. We have found no large surgical series describing its treatment and outcome.

Methods: A retrospective review of all patients treated surgically for this tumor from 1985 to 2002.

Sinus venosus atrial septal defect: long-term postoperative outcome for 115 patients.

Background: Sinus venosus atrial septal defect (SVASD) differs from secundum atrial septal defect by its atrial septal location and its association with anomalous pulmonary venous connection (APVC). Data on long-term outcome after surgical repair are limited.

Methods And Results: We reviewed outcomes of 115 patients (mean age+/-SD 34+/-23 years) with SVASD who had repair from 1972 through 1996.

Long-term results of the Fontan operation for double-inlet left ventricle.

The purpose of this study was to quantify and determine predictors of long-term survival and functional outcome in patients with double-inlet left ventricle (DILV) after the Fontan operation. The Fontan operation has become the procedure of choice for DILV. Early survival has improved, but mortality and morbidity persist.

Surgical management of the aortic root in patients with Marfan syndrome.

Background And Aim Of The Study: Surgical aortic root reconstruction techniques are standard therapy to avoid catastrophic vascular events in patients with Marfan syndrome with a dilated and/or dissected aortic root. The study aim was to evaluate the long-term results of aortic root reconstruction.

Methods: Eighty-three patients (54 males, 29 females; mean age 37+/-17 years) fulfilling strict Ghent criteria for Marfan syndrome underwent aortic root surgery between 1971 and 2001.

Operative risk of reoperative aortic valve replacement.

Objective: The contemporary risk of reoperative aortic valve replacement is ill-defined. We therefore compared the recent early results of reoperative and primary aortic valve replacement in our institution.

Methods: Between January 1993 and January 2001, a total of 162 patients underwent reoperative aortic valve replacement with or without coronary artery bypass grafting, and 2290 underwent primary aortic valve replacement with or without coronary artery bypass grafting.

Mitral and tricuspid valve repair in patients with previous mediastinal radiation therapy.

Background: The purpose of this study was to evaluate outcomes of mitral and tricuspid valve repair after mediastinal radiation therapy.

Methods: From 1976 to 2001, 22 patients (mean age 61 +/- 14 years) underwent mitral (n = 14), tricuspid (n = 6), or both (n = 2) valve repairs 15 +/- 9 years after mediastinal radiation therapy. Concomitant procedures included coronary artery bypass graft, 11 patients; valve replacement, 6 patients (4 aortic, 3 mitral, 1 tricuspid, and 1 pulmonary); and pericardiectomy, 4 patients.