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Alessandro Mazzucco - One of the best experts on this subject based on the ideXlab platform.
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survival after stentless and stented xenograft Aortic valve replacement a concurrent controlled trial
The Annals of Thoracic Surgery, 2002Co-Authors: Giovanni Battista Luciani, Francesco Santini, Gianluca Casali, Stefano Auriemma, Alessandro MazzuccoAbstract:Abstract Background To define the impact of stentless versus stented valve design on survival late after xenograft Aortic valve replacement, a retrospective analysis of all consecutive patients operated on between January 1992 and April 2000 was undertaken. Methods Two hundred ninety-two patients had stented (group 1) and 376 stentless (group 2) xenograft Aortic valve replacements. Age was older in group 1 (75 ± 4 vs 70 ± 7 years, p = 0.01), whereas male gender and Aortic stenosis were equally prevalent. Advanced New York Heart Association class III-IV (85% vs 78%, p = 0.03) and associated procedures (53% vs 41%, p = 0.01) were more common in group 1. Aortic Cross-Clamp (80 ± 28 vs 96 ± 23 minutes, p = 0.01) and bypass (91 ± 56 vs 129 ± 34 minutes, p = 0.01) times were shorter in group 1. Logistic regression and Cox proportional hazard methods were used to define the role of demographic and operative variables on hospital and late survival, freedom from valve-related mortality, and reintervention. Results Early mortality was higher in group 1 (6.2% vs 2.6%, p = 0.02). Smaller Aortic anulus ( p = 0.008), Aortic Cross-Clamp ( p = 0.03), and coronary disease requiring bypass ( p = 0.03) were associated with hospital mortality. During follow-up (37 ± 30 vs 43 ± 35 months, p = NS), 66 late deaths were recorded (12% vs 9%, p = NS). At 8 years, survival (70 ± 5% vs 81 ± 3%, p = 0.01), freedom from cardiac- (85 ± 1% vs 92 ± 3%, p = 0.02), and valve-related death (79 ± 5% vs 95 ± 2%, p = 0.004) were higher in group 2. Freedom from structural deterioration was similar (92 ± 5% vs 93 ± 3%, p = NS), but freedom from reoperation was lower in group 2 (99 ± 1% vs 90 ± 4%, p = 0.009). Multivariate analysis showed female gender ( p = 0.02), age ( p = 0.03), and smaller valve size ( p = 0.05) to be associated with late mortality; age ( p = 0.06) and diagnosis of Aortic stenosis ( p = 0.008) with cardiac mortality; longer intensive care unit stay ( p = 0.001) and stented xenografts ( p = 0.05) with valve-related mortality; and younger age ( p = 0.01) and stentless xenograft ( p = 0.05) with reoperation. Conclusions Use of stentless xenografts correlates with better survival and freedom from cardiac- and valve-related mortality than stented valves. However, bias favoring stented valves in older and sicker patients exists. Selective survival advantage of stentless xenograft is confined to valve-related mortality. Stentless valves are more likely to be replaced for dysfunction.
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Single Aortic Cross-Clamp technique in coronary surgery: A prospective randomized study
European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery, 1997Co-Authors: Paolo Bertolini, Francesco Santini, Giuseppe Montalbano, Renzo Pessotto, Alessandro MazzuccoAbstract:Objective: To test the hypothesis of an improved myocardial and cerebral protection by combining blood cardioplegia and the single Aortic Cross-Clamp technique, 100 patients were enrolled in a prospectively randomized study and stratified for preoperative conditions. Methods: In Group I, 55 patients underwent myocardial revascularization using crystalloid cardioplegia and the conventional partial occluding clamp technique to perform proximal anastomoses, whereas in Group II, 45 patients were operated on combining blood cardioplegia and the single Aortic Cross-Clamp technique. Unstable angina, emergency procedures, reoperations and preoperative counterpulsation accounted for an higher risk score in group II patients (P< 0.03). Operations were performed by the same surgical team. Aortic Cross-Clamp time was significantly longer in group II patients (59 ± 22 vs. 47 ± 18 min.) (P
Stephen E. Fremes - One of the best experts on this subject based on the ideXlab platform.
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Intermittent Warm Blood Cardioplegia
Circulation, 1995Co-Authors: Samuel V. Lichtenstein, C. David Naylor, Christopher M. Feindel, Kathy Sykora, James G. Abel, Arthur S. Slutsky, C. David Mazer, George T. Christakis, Bernard S. Goldman, Stephen E. FremesAbstract:Background Warm heart surgery implies continuous perfusion with normothermic blood cardioplegia. Interruption of cardioplegia, however, facilitates construction of distal coronary anastomoses and is the method practiced by many surgeons. To determine whether intermittency is harmful, we present results from 720 coronary bypass patients, protected with intermittent antegrade warm blood cardioplegia, that were derived from a previous study of normothermic versus hypothermic cardioplegia. Methods and Results Mean±SD age was 60.8±9.0 years; 27% of cases were urgent; 16% of patients had >50% left main stenosis, and 19% had grade III or IV ventricles. A mean of 3.2±0.9 grafts was constructed. The average Aortic Cross-Clamp time was 61.8±22.2 minutes. The longest single time off cardioplegia (LTOC) averaged 11.4±4.0 minutes per patient. The cumulative time off cardioplegia as a percentage of the Cross-Clamp time (PTOC) was 48.2±18.6% per patient. LTOC and PTOC were divided into quartiles (LTOC,
Graham Cooper - One of the best experts on this subject based on the ideXlab platform.
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single Aortic cross clamp technique reduces s 100 release after coronary artery surgery
The Annals of Thoracic Surgery, 2001Co-Authors: Mudassir I Dar, Timothy Gillott, Franco Ciulli, Graham CooperAbstract:Abstract Background . Neurologic impairment after coronary artery bypass grafting is associated with cerebral embolization. An important cause of embolism is Aortic manipulation. Constructing both distal and proximal anastomoses during a single period of Aortic Cross-Clamping avoids this source of embolism and may reduce neurologic injury after coronary artery bypass grafting. Methods . Fifty consecutive patients undergoing coronary artery bypass grafting were prospectively randomized to group 1, in which a single Aortic Cross-Clamping was used to construct distal and proximal anastomoses, or to group 2, in which the proximal anastomoses were each constructed with a partial occluding Aortic clamp. Levels of S-100 and troponin-T release were measured preoperatively and postoperatively. Results . Aortic Cross-Clamp time was significantly longer in group 1, but other preoperative and intraoperative variables were equally represented in both groups. Control group levels of S-100 and troponin-T were similar. Postoperative S-100 levels were significantly higher in group 2 than in group 1 ( p Conclusions . The results of this trial suggest improved cerebral protection is associated with the single Aortic Cross-Clamp technique for coronary artery bypass grafting with no increase in myocardial damage. The single Aortic Cross-Clamp technique is simple and inexpensive. We recommend its wider use.
X Roques - One of the best experts on this subject based on the ideXlab platform.
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early to midterm results of total cavopulmonary connection in adult patients
The Annals of Thoracic Surgery, 2013Co-Authors: Francois Roubertie, J Peltan, Roland Henaine, Pierre Oses, Xavier Iriart, Jeanbenoit Thambo, Nadir Tafer, X RoquesAbstract:Background Total cavopulmonary connection (TCPC) has not been studied in adults. We investigated early and midterm morbidity and mortality in adults undergoing TCPC and assessed risk factors for mortality. Methods Between June 1994 and October 2010, 30 adults (21.3 ± 5.5 years) underwent TCPC (extracardiac conduit). Twenty-two patients who had palliated single ventricles underwent TCPC completions and 8 patients underwent TCPC conversions. Preoperative and perioperative data were reviewed retrospectively. Results Six of 9 patients with preoperative atrial flutter or fibrillation or intraatrial reentry tachycardia were treated in the catheterization room. An Aortic Cross-Clamp was necessary in 12 patients, and 16 TCPCs were fenestrated. Mean follow-up was 51 months (range, 4–198 months). Early mortality was 10%: 2 of 8 conversions and 1 of 22 completions. There was 1 late conversion death (at 56 months postoperatively). Postoperatively, 4 patients required pacemakers and 1 patient required long-term antiarrhythmic medication, but no heart transplantations were necessary. Risk factors for early mortality were arrhythmia ( p = 0.02), Aortic Cross-Clamp ( p = 0.054), and extracorporeal circulation in hypothermia ( p = 0.03). Risk factors for overall mortality were conversion ( p = 0.047), absence of fenestration ( p = 0.036), surgery before January 2006 ( p = 0.036), Aortic Cross-Clamp ( p = 0.018), extracorporeal circulation in hypothermia ( p = 0.008), and arrhythmia ( p = 0.005). New York Heart Association functional class had improved at the last follow-up: preoperatively, 17 patients were in class II and 12 patients were in class III versus 18 patients in class I and 9 patients in class II postoperatively ( p Conclusions Early and midterm TCPC results for adults are encouraging for completion but are disappointing for conversion. Identified risk factors for mortality should improve patient selection for TCPC.
Robert A Guyton - One of the best experts on this subject based on the ideXlab platform.
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prospective randomized trial of retrograde warm blood cardioplegia myocardial benefit and neurologic threat
The Annals of Thoracic Surgery, 1994Co-Authors: Tomas D Martin, Joseph M Craver, John Parker Gott, William S Weintraub, James Ramsay, Christine T Mora, Robert A GuytonAbstract:Abstract From March 1991 through July 1992, 1,001 patients having elective coronary artery bypass grafting were randomized to receive either continuous warm (≥35 °C) blood cardioplegia with systemic normothermia (≥35 °C) or intermittent cold (≤8 °C oxygenated crystalloid cardioplegia and moderate systemic hypothermia (≤28 °C). Preoperative variables including age, sex, prior coronary bypass grafting, hypertension, prior myocardial infarction, diabetes, angina class, and preoperative heart failure class were similar in both groups, as were the intraoperative variables of number of coronary grafts, mammary artery use, and cardiopulmonary bypass time. Aortic Cross-Clamp time was significantly longer in the warm group (46 ± 23 minutes versus 40 ± 21 minutes). Most postoperative variables including mortality (warm, 1.0%, and cold, 1.6%), Q wave infarction (warm, 1.4%, and cold, 0.8%), and need of an intraAortic balloon pump (warm, 1.4%, and cold, 2.0%) were similar between groups. Total neurologic events (warm, 4.5%, and cold, 1.4%; p p ≤ 0.02) were significantly higher in the warm group. Neurologic events included perioperative stroke (warm, 15 patients, and cold, 5 patients; p
