Early- and Long-Term Outcomes of Mitral Valve Repair in a Low-Volume Centre in the Caribbean.

Introduction: This study examines early- and long-term outcomes of mitral valve repairs in a low-volume cardiac surgery centre in the Caribbean.

Methods: Ninety-six consecutive patients underwent mitral valve repair from April 2009 to December 2018. Patients were divided into two groups: functional mitral regurgitation requiring simple mitral annuloplasty (FMR, n=63) or structural degenerative mitral regurgitation requiring more complex repair (DMR, n=33).

Rupture of sinus of Valsalva aneurysm: case report and review of contemporary literature.

Sinus of Valsalva aneurysm rupture is a rare condition with a great potential for morbidity and mortality if not promptly diagnosed and managed. We present an unusual non-infected sinus of Valsalva aneurysm rupture in a 47-year-old female. This case report, a likely presentation of a late congenital heart defect, highlights the need for a high index of suspicion in a patient with atypical history of congestive cardiac failure.

Adult cardiac surgery in Trinidad and Tobago during the COVID-19 pandemic: Lessons from a developing country.

Background And Aim: The coronavirus disease 2019 (COVID-19) pandemic has seen the cancellation of elective cardiac surgeries worldwide. Here we report the experience of a cardiac surgery unit in a developing country in response to the COVID-19 crisis.

Methods: From 6th April to 12th June 2020, 58 patients underwent urgent or emergency cardiac surgery.

Developing a cardiac surgery unit in the Caribbean: A reflection.

Background And Aim: Access to specialized cardiac surgery is a problem in emerging countries. Here, we reflect on the approach we used to establish a cardiac surgery unit in Trinidad and Tobago.

Methods: The program started in 1993 with monthly visits by a team from Bristol Heart Institute.

Transfusion related acute lung injury with massive pulmonary secretion during cardiac surgery. A case report.

A Indo-Caribbean patient undergoing cardiac surgery developed Transfusion Related Acute Lung Injury (TRALI) with massive endobronchial secretion of clear fluid mimicking severe pulmonary edema. Hypoxemia and lung stiffness were so severe that didn't allow closure of the sternum on completion of surgery. The patient was treated with invasive ventilation, high positive pressure and % FiO2 and aggressive endotracheal suction.

Double patch repair through a single ventriculotomy for ischemic ventricular septal defects.

We present a novel postinfarction ventricular septal defect repair, through a single ventriculotomy, using a biseptal double patch and gelatin-resorcinol-formaldehyde glue. This technique reduces the postoperative recurrence of ventricular septal defects by reducing the tension on the patch sutures and by preventing blood from infiltrating into the suture lines within the ventricular septal defect cavity.

Ventricular fibrillation in acute mitral valve insufficiency caused by chordae tendineae rupture: report of a surgically corrected case.

In this report, we present the case of a previously healthy 80-year-old woman who was referred to surgery after a cardiac arrest due to ventricular fibrillation successfully resuscitated; the following evaluation revealed acute mitral regurgitation due to chordae tendineae rupture. After mitral valve repair, a single-chamber cardioverter-defibrillator was implanted for secondary prevention of sudden cardiac death. After 16 months of follow-up, the patient is asymptomatic without any further episodes of ventricular arrhythmias reported, underlying the pivotal role of mitral valve repair in the prevention of potentially lethal ventricular arrhythmias.

Successful surgical treatment of a giant coronary aneurysm communicating with the right atrium.

Aneurysms of the coronary arteries are rare events. In most cases, such abnormalities are clinically silent and, when they cause symptoms, there are dyspnea and/or angina. Our report describes a case presenting with dyspnea; the admission electrocardiogram demonstrated largely spread ischemia in the lower-lateral leads and myocardial necrosis in the inferior wall.

Intracoronary infusion of levosimendan to treat postpericardiotomy heart failure.

Systemic hypotension limits the intravenous use of levosimendan, particularly in coronary disease. Published reports show that the intracoronary administration of levosimendan in animal models causes an increase of coronary blood flow without systemic hypotension. In this case report, the intracoronary administration of levosimendan bolus in a 74-year-old man with postpericardiotomy heart failure elicited beneficial cardiac effects, increasing both systolic and diastolic functions and blood flow in all of the grafts.

Overreduction of the posterior annulus in surgical treatment of degenerative mitral regurgitation.

Background: The concept of overreduction of the posterior annulus was applied in surgical treatment of degenerative mitral valve disease.

Methods: From April 1993 to November 2004, 141 patients underwent overreduction of the posterior annulus of the mitral valve in mitral valve repair for degenerative disease. Mean scallop involvement per patient was 2.

Use of the inferior epigastric artery for CABG.

Presentation of the inferior epigastric artery as conduit for coronary artery bypass grafting (CABG): harvesting, use and results.

Single versus bilateral internal mammary artery for isolated first myocardial revascularization in multivessel disease: long-term clinical results in medically treated diabetic patients.

Background: We evaluated our experience to investigate if the use of bilateral internal mammary artery (BIMA) grafting, with or without complementary saphenous vein grafts (SVG), increases the quality of the results of coronary bypass grafting in medically treated diabetic patients who undergo first myocardial revascularization, when compared with the use of a single left internal mammary artery (LIMA) and SVG.

Methods: From October 1991 to December 2001, 558 diabetic patients with multivessel coronary disease had first isolated myocardial revascularization using LIMA and SVG (group LIMA) in 217 cases and BIMA +/- SVG (group BIMA) in 341. Propensity score analysis identified 400 patients, 200 for each group, with similar preoperative characteristics.

Bilateral internal thoracic artery grafting with and without cardiopulmonary bypass: six-year clinical outcome.

Objectives: We sought to evaluate whether early and late results in patients who underwent off-pump or on-pump myocardial revascularization with bilateral internal thoracic artery grafting were similar.

Methods: From November 1994 through December 2001, 1835 patients underwent isolated myocardial revascularization with bilateral internal thoracic artery grafting. By applying propensity score pairwise matching, 1194 patients were selected and operated on either off pump (n = 597) or on pump (n = 597).

Reoperative coronary artery bypass grafting: analysis of early and late outcomes.

Background: The purpose of this study was to evaluate early and late results of reoperative coronary artery bypass grafting compared with those of first coronary artery bypass grafting.

Methods: From November 21, 1994, to December 31, 2001, 4,381 patients underwent isolated coronary revascularization: among these patients, 274 (6.3%) underwent a redo.

Late results of first myocardial revascularization in multiple vessel disease: single versus bilateral internal mammary artery with or without saphenous vein grafts.

Objective(s): We evaluated our experience to investigate if the use of bilateral internal mammary artery (BIMA) grafting, with or without complementary saphenous vein grafts (SVGs), if compared to the use of single IMA and SVG(s), increases the quality of the results of coronary bypass grafting in patients younger than 75 years who undergo first myocardial revascularization.

Methods: From September 1986 to December 1999, 1602 patients younger than 75 years underwent first myocardial revascularization using left internal mammary (LIMA) to left anterior descending (LAD) and SVG(s) (n=576) or BIMA (one IMA on the LAD) with or without SVG(s) (n=1026). Propensity score analysis was used to select 1140 patients with the same preoperative and operative characteristics.

Midterm results after septal reshaping for anteroseptal scars.

Background: Midterm clinical and morphologic results of the septal-reshaping exclusion of anteroseptal dyskinetic or akinetic areas were evaluated.

Methods: From January to June 2003, 44 patients with myocardial infarction following left anterior descending coronary artery (LAD) occlusion underwent septal reshaping. The mean (+/- SD) New York Heart Association (NYHA) class of the patients at admission was 2.

Partial clamping of the brachiocephalic trunk for total ascending aorta replacement without circulatory arrest: early and midterm results.

Background: The aim of this study was to evaluate in elective patients the early and midterm results of partial clamping of the brachiocephalic trunk (BCT) for total ascending aorta replacement (TAAR) without circulatory arrest. Contraindications to the procedure were BCT/aortic arch calcifications and chronic aortic dissection.

Methods: The right radial artery was cannulated to monitor the systemic pressure after the BCT was partially clamped.

Myocardial revascularization with and without cardiopulmonary bypass in multivessel disease patients.

Background: Off-pump coronary artery bypass surgery is widely performed because of its proved safety, but its effectiveness remains controversial. The aim of this retrospective study was to compare early and late results in patients with multivessel disease, operated on off-pump and on-pump.

Methods: From November 1994 to December 2001, 2957 patients with multivessel disease underwent isolated coronary revascularization, on-pump (n = 1924) and off-pump (n = 1033).

Mitral valve surgery for chronic ischemic mitral regurgitation.

Background: Early and midterm clinical and echocardiographic results after mitral valve (MV) surgery for chronic ischemic mitral regurgitation were investigated to evaluate the validity of the criteria for repair or replacement applied by us.

Methods: From 1988 to 2002, 102 patients with ischemic mitral regurgitation underwent MV surgery (82 repairs and 20 replacements). End-systolic distance between the coaptation point of mitral leaflets and the plane of mitral annulus was the key factor that allowed either repair (10 mm).

Left ventricular aneurysmectomy: endoventricular circular patch plasty or septoexclusion.

Background: Septoexclusion is a technique described by Guilmet in the mid 1980s. Its indications and midterm results are evaluated and compared to those obtained with the Dor operation.

Methods: From January 1998 to April 2001, 79 patients had an exclusion of scars following myocardial infarction in left anterior descending artery (LAD) territory.

Doxorubicin-dependent reduction of ferrylmyoglobin and inhibition of lipid peroxidation: implications for cardiotoxicity of anticancer anthracyclines.

Lipid peroxidation has been proposed to mediate cardiotoxicity induced by doxorubicin (DOX) and other anticancer anthracyclines; however, there have been reports showing that DOX can also inhibit lipid peroxidation. Here we characterized the effects of DOX on the oxo-ferryl moiety [Fe(IV)=O, Mb(IV)] of H(2)O(2)-activated myoglobin, a lipid oxidant likely formed in the heart during treatment with DOX. Mb(IV) was formed in vitro by reacting 100 microM H(2)O(2) with 50 microM horse heart metmyoglobin (Mb(III)).

Impact of aortic manipulation on incidence of cerebrovascular accidents after surgical myocardial revascularization.

Background: The impact of aortic manipulation on incidence of cerebrovascular accidents (CVAs) was evaluated in patients who underwent myocardial revascularization.

Methods: From January 1988 to December 2000, 4,875 patients had coronary operations; 33 who survived less than 24 hours and 19 who had aortic cannulation without cross-clamping were excluded. According to the degree of aortic manipulation, patients were divided into two groups: group A, aortic cannulation, cross-clamping, with (A1, n = 597) or without (A2, n = 2,233) side-clamping, and group B, with (B1, n = 460) or without (B2, n = 1,533) side-clamping.

Day 0 intensive care unit discharge - risk or benefit for the patient who undergoes myocardial revascularization?

Objective: Day 0 intensive care unit (ICU) discharge allows to use one ICU bed for two patients. Results of this policy were analysed.

Methods: From January 1998 to June 2001, 1194 patients who had myocardial revascularization in the morning were discharged on the same day (Group 0, n=647), or one (Group 1, n=521) or many days (Group 2, n=26) after surgery.

Revascularization of the lateral wall: long-term angiographic and clinical results of radial artery versus right internal thoracic artery grafting.

Objective: We sought to evaluate whether the radial artery provides the same results as the right internal thoracic artery in lateral wall revascularization in the long term.

Methods: From January 1992 to September 1996, 288 patients had myocardial revascularization with the left internal thoracic artery anastomosed to the left anterior descending coronary artery. The lateral wall was grafted with the radial artery in 139 patients (group A) and with the right internal thoracic artery in 149 patients (group B).