Aortic valve replacement: a prospective randomized evaluation of mechanical versus biological valves in patients ages 55 to 70 years.

Objectives: The aim of this study was to determine long-term results between bioprosthetic (BP) and mechanical (MP) aortic valves in middle-aged patients.

Background: It has not been established which is the best aortic valve substitute in patients ages 55 to 70 years. We conducted a randomized study to compare long-term outcomes between BP and MP aortic valves.

Surgery for left ventricular aneurysm: is there still any role for simple linear repair?

The aim of left ventricular aneurysm (LVA) surgery is to eliminate the diskinetic portion of the left ventricle and to restore the patient's clinical condition. This can be obtained with two surgical procedures: linear repair and endoventricular patch technique. We investigated early- and long-term results in patients who underwent both procedures.

Aortic valve replacement and coronary artery surgery: determinants affecting early and long-term results.

Background: We studied factors influencing early and late results in patients operated on for aortic valve replacement and coronary artery bypass graft.

Methods: 175 patients were retrospectively analysed over a 10-year period ending in December 2002. There were 135 males and 40 females with a mean age of 62.

A single-stage procedure for carotid endarterectomy and myocardial revascularization: early and late results.

Cardiac events are some of the most frequent postoperative complications of carotid endarterectomy, while cerebrovascular accidents frequently occur in patients who have undergone coronary artery bypass grafting. The strategy for treatment of combined carotid and coronary artery disease is still controversial. We report our experience with a single-stage procedure for carotid endarterectomy and myocardial revascularization during cardiopulmonary bypass; then we evaluate our early and late results.

Endovascular vs. open surgery of abdominal aortic aneurysm in high-risk patients: a single center experience.

Background: We compared two groups of high-risk patients with abdominal aortic aneurysm to assess the safety and efficacy of endovascular repair vs. open surgery.

Methods: From January 1998 to July 2003, sixty-two high-risk patients were divided into two groups: group A consisted of 28 (46 %) open surgery patients and group B consisted of 34 (54 %) patients who underwent endovascular repair.

Discrete subaortic stenosis: long-term prognosis on the progression of the obstruction and of the aortic insufficiency.

Background: We sought to determine the long-term rate of progression of left ventricular outflow tract (LVOT) obstruction and aortic insufficiency (AI) in adult patients operated on for discrete subaortic stenosis (DSS).

Methods: Between 1975 and 1995, 52 patients underwent surgery for DSS; their mean age was 25.4 +/- 14.

Mitral valve replacement and limited myectomy for hypertrophic obstructive cardiomyopathy: a 25-year follow-up.

Hypertrophic obstructive cardiomyopathy is a dynamic obstruction of the left ventricular outflow tract caused by septal hypertrophy and systolic anterior motion of the mitral valve. When the condition cannot be controlled by medical therapy the most frequently used surgical approach is left ventricular myotomy-myectomy. Mitral valve replacement (to correct another mechanism of obstruction) is another surgical option; however, its use for this condition is controversial.

Thoracic aortic emergencies: impact of endovascular surgery.

Background: Conventional surgery for thoracic aortic emergencies, such as contained or free rupture of thoracic aortic aneurysms, acute type B dissections, and traumatic rupture of the thoracic aorta, is frequently associated with a high rate of mortality and morbidity. To obviate this risk, endovascular surgery is considered to be a valid alternative procedure.

Methods: From March 2001 to July 2002, 15 of 22 patients with acute thoracic aortic syndromes were submitted to endovascular surgery: 3 patients (20%) for traumatic rupture, 4 patients (26.

Can epsilon-aminocaproic acid balance the off-pump bleeding advantage?

Background: Aprotinin improved the control of bleeding in patients undergoing surgery with cardiopulmunary bypass, but its use was halted because of the risk of bovine spongiform encephalopathy. We then started to use epsilon-aminocaproic acid and the results in the control of bleeding were satisfactory. To assess its effectiveness in the control of postoperative bleeding precisely, we compared the results for patients operated on for myocardial revascularization on-pump and treated with epsilon-aminocaproic acid with those for patients who decidedly bleed less: off-pump patients.

[Right heart failure in a patient with giant mediastinal dermoid cyst].

This case report describes the management of a rare giant mediastinal dermoid cyst causing right heart compression and failure. The precise relationships with vital structures were preoperatively defined at transesophageal echocardiography and computed thoracic tomography. These allowed us to predict the likely diagnosis and therefore plan a limited surgical approach.

Detection of postoperative pseudoaneurysms following abdominal aortic aneurysm repair in Behçet's disease by MRA.

We report the development of two anastomotic pseudoaneurysms in a patient with Behçet's disease eighteen months after abdominal aortic aneurysm repair. Major asymptomatic vascular complications should be suspected in patients with Behçet's disease with a history of vascular surgery and treated expediently due to the risk of rupture. Magnetic resonance angiography, contrast-enhanced computed tomography or ultrasound scanning should be performed at least every 6 months after vascular surgery.

One-stage coronary and abdominal aortic operation with or without cardiopulmonary bypass: early and midterm follow-up.

Background: The aim of this study was to compare hospital, early, and late clinical outcomes for patients undergoing one-stage, coronary and abdominal aortic surgical intervention with and without cardiopulmonary bypass.

Methods: From March 1990 to September 1999, 42 consecutive patients underwent combined operations at a single institution. Cardiopulmonary bypass and cardioplegic arrest were used during coronary revascularization in the first 20 patients (on-pump group), and the next 22 patients received the one-stage operations on the beating heart (off-pump group).

L-arginine improves post-ischemic vasodilation in coronary heart disease patients taking vasodilating drugs.

Background: The hypothesis that intravenous L-arginine infusion improves the vasodilatory response to ischemia in the resistance vessels of human lower limbs in relatively young coronary heart disease patients taking vasodilating drugs was tested.

Methods: Twenty patients with onset of symptoms of coronary artery disease before age 50, operated for aortocoronary bypass and taking vasodilating drugs, were compared with 20 control subjects of comparable age and gender; neither group included heavy smokers (>10 cigarettes/day). Blood flow in the lower limbs was measured noninvasively with strain-gauge plethysmography, both at rest and during a reactive hyperemia test.

Surgical myocardial revascularization (CABG) in patients with pulmonary disease: beating heart versus cardiopulmonary bypass.

Background: Adverse effects on the respiratory system can be severe in many instances after coronarv artery bypass grafting (CABG) with cardiopulmonary bypass (CPBP). Recently, operative techniques without CPBP have gained widespread consent, thanks to the newly developed retractors that allow satisfactory immobilisation of the surgical field.

Methods: Thirty-seven patients operated upon in our Institution between April 1997 and April 1998 showed an obstructive and/or restrictive pulmonary disease.

Mid-term results of the valve-on-valve technique for bioprosthetic failure.

Objective: Redo operations for bioprosthesis malfunction can sometimes be technically very demanding and cardiac structures may be damaged. Excising only the leaflets of the damaged bioprosthesis and leaving the old ring in situ on which the 'new' mechanical valve is sutured can, in very selected cases, represent a solution.

Methods: Twenty-two patients were operated on, with the valve-on-valve technique, from September 1991 through December 1992.

Combined coronary artery and abdominal aortic surgery without cardiopulmonary bypass.

To determine the effects of beating heart surgery on patients undergoing simultaneous coronary artery bypass grafting and abdominal aortic surgery, we performed such surgery on 20 patients (mean age, 64.55+/-796 SD years). Abdominal aortic disease was defined as an abdominal aortic aneurysm larger than 5 cm in diameter or as end-stage aortic occlusive disease.

[The complications of implantable cardioverter-defibrillators and their treatment].

Infection of implantable cardioverter defibrillator (ICD) is a devastating event. In an effort to more fully understand ICD infection, the authors reviewed patients records recommending a strategy for management based on their satisfactory experience. From March 1993 through May 1998, 85 ICD were implanted in 64 male and 21 female patients.

Determinants of aortic artifacts during transesophageal echocardiography of the ascending aorta.

Background: The origin of artifacts of the ascending aorta during transesophageal echocardiography has not been widely studied. This study was undertaken to investigate in vivo whether anatomic features could determine the appearance of artifacts.

Methods And Results: Transesophageal echocardiograms of 46 patients studied for suspected dissection with proven diagnosis (30 patients with and 16 without ascending aortic dissection) were reviewed.

Bioprosthetic replacement after bioprosthesis failure: a hazardous choice?

Background: Following bioprosthetic failure, replacement is usually done with mechanical valves to avoid repeated reoperations.

Methods: From 1986 to 1996 we operated on 130 patients with bioprosthetic failure, implanting a new bioprosthesis; this group included patients with contraindication to anticoagulation, tricuspid replacement, and specific patient requests. Mean age was 63+/-8 years.

Open chest myocardial biopsy: a simple and safe method.

The authors describe a simple method to perform left ventricular biopsies during open heart surgery. An automatic gun shaped device is used by one hand of the surgeon: the sample is obtained in a few seconds, at any time of the surgical procedure. It consists of a transmural piece of tissue, averaging 18 mm3 in quantity.

Intermittent warm blood cardioplegia preserves myocardial beta-adrenergic receptor function.

Background: Left ventricular dysfunction is frequently observed in patients after hypothermic cardioplegic arrest, and often inotropic intervention is necessary for patients to be successfully weaned from cardiopulmonary bypass (CPB). A myocardial beta-adrenergic receptor (beta AR) desensitization has been noted to occur after hypothermic CPB in patients undergoing coronary artery bypass grafting. This randomized study was undertaken to determine the effect of cardioplegic solution temperature on cardiac beta ARs.

Aortic valve replacement through a minimally invasive approach.

Minimally invasive cardiac surgery is rapidly gaining interest because of fast recovery, reduced morbidity, shorter hospital stay, lower costs, and better cosmetic results. Aortic valve surgery can be performed through a small (10- to 12-cm) transverse sternal incision, and femoro-femoral cannulation is used for cardiopulmonary bypass. Exposure of the ascending aorta is satisfactory.

Role of catheter-induced mechanical trauma in localization of target sites of radiofrequency ablation in automatic atrial tachycardia.

Objectives: We compared the efficacy of two different mapping techniques in identifying the ablation site for atrial tachycardia. Moreover, we evaluated the additive positive predictive value of mechanical interruption of atrial tachycardia to reduce the number of ineffective radiofrequency applications.

Background: Radiofrequency catheter ablation has been suggested as a highly effective technique to treat drug-resistant atrial tachycardia.