Long-term clinical outcome of mitral valve repair in asymptomatic severe mitral regurgitation.

Objective: To assess the long-term survival, the incidence of cardiac complications and the factors that predict outcome in asymptomatic patients with severe degenerative mitral regurgitation (MR) undergoing mitral valve repair.

Methods: Up to 143 asymptomatic patients (mean age 63+/-12 years) with severe degenerative MR who underwent mitral valve repair between 1990 and 2001 were subsequently followed up for a median of 8 years. The study population was subdivided into three subgroups: patients with left ventricular (LV) dysfunction and/or dilatation (n=18), patients with atrial fibrillation and/or pulmonary hypertension (n=44) and patients without MR-related complications (n=81).

Functional classification of aortic root/valve abnormalities and their correlation with etiologies and surgical procedures.

Purpose Of Review: Patients with aortic root pathology may benefit from 'valve-conservation' surgery although application of this philosophy is limited by a lack of 'standardized' surgical techniques. A functional classification of aortic root and valvular abnormalities has been developed in 260 patients and correlated with the etiology of the pathologic process and the surgical procedure performed. Early outcome was assessed using hospital records and medium-term follow-up by cardiological review.

Repair of aortic valve prolapse: experience with 44 patients.

Objectives: In regurgitant tricuspid aortic valves, cusp prolapse may be isolated or associated with dilatation of the proximal aorta. Newly appearing cusp prolapse can also appear after an aortic valve sparing operation (AVSO) and be responsible for residual aortic regurgitation. In this report, we describe our experience in repairing prolapsing aortic cusps in 44 patients with aortic regurgitation.

[About the rational use of intrathoracic transfers. Anatomical and surgical bases for the selection of twelve different muscular and omental flaps].

Because of their rich blood supply and of their original detersive and filling properties, the muscular pedicled flaps harvested from the trunk or the omental flap elevated from the abdomen may be very usefull to treat large defects or major septic problems in pleural, pericardic or mediastinal cavities. We here describe the main principles to be followed in such intrathoracic reconstructions performed in order to control severe mediastinites, aortic prosthetic infections, pleural empyemas and broncho-pleural, tracheo-esophageal or broncho-esophageal fistulas. In all these circumstances, the muscular or omental flaps which are transferred into the chest are selected according to the recipient field and to their respective access to the upper, middle and lower portions of the pleural space or mediastinum.

Bone marrow micrometastasis might not be a short-term predictor of survival in early stages non-small cell lung carcinoma.

Objective: To determine the presence of occult micrometastasis (OM) in a selected population of surgically resectable patients presenting with non-small cell lung carcinoma (NSCLC) and to evaluate its prognostic value on relapses and survival.

Methods: From February 1996 to December 1999, 99 patients undergoing surgical treatment for NSCLC were prospectively investigated for the presence of occult bone marrow micrometastasis. Tumor cells were detected with monoclonal primary antibodies directed against low molecular weight cytokeratins.

Retrospective study of somatosensory evoked potential monitoring in deep hypothermic circulatory arrest.

Background: We evaluated the efficiency of median-nerve somatosensory evoked potentials (SEPs) monitoring in determining the optimal level of hypothermia in 62 consecutive patients operated on under deep hypothermic circulatory arrest (CA).

Methods: CA was started at 1 degree C below the temperature at which both brainstem and cortical SEP components disappear. No additional method of cerebral protection was used.

Recycling of arterial grafts during reoperative coronary artery operations.

Background: To overcome problems of lack of conduit and to maximize the number of arterial anastomoses in coronary reoperations we reused previously placed arterial grafts.

Methods: Sixteen patients were identified from February 1994 to July 1997. Mean age was 62.

Randomized trial of intermittent antegrade warm blood versus cold crystalloid cardioplegia.

Background: We performed a prospective randomized trial to compare intermittent antegrade warm blood cardioplegia with intermittent antegrade and retrograde cold crystalloid cardioplegia.

Methods: Two hundred consecutive patients scheduled for isolated coronary bypass surgical procedures were randomized into two groups: Group 1 (n = 92) received cold crystalloid cardioplegia with moderate systemic hypothermia, group 2 (n = 108) received intermittent antegrade warm blood cardioplegia with systemic normothermia. Preoperative, intraoperative, and postoperative data were prospectively collected.