摘要:

AbstractThe Possis® polytetrafluoroethylene Permaflow coronary graft incorporates a Venturi resistor within the graft. Insertion is constructed by creating an anastomosis to the superior vena cava with subsequent anastomoses in sequence to coronary arteries requiring grafting. Finally, the graft is sewn to the aorta. The Venturi resistor controls flow through the aortocaval fistula, maintaining systemic pressure proximal, permitting systolic and diastolic flow to the grafted coronary arteries while maintaining constant flow through the graft. Animal studies demonstrated long‐term patency. This graft was implanted in a patient with unstable angina pectoris and inadequate native conduit. Catheterization 6 weeks postoperative revealed patency of all anastomoses. (J Card Surg 1993; 8:439

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1993.tb00391.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

AbstractMost surgical techniques for reconstruction of the aortic valve, although described a long time ago, are now feasible with satisfactory results. The general surgical principles for successful reconstruction, and the operative techniques of annuloplasty, commissurotomy, free edge resuspension, unrolling and thinning, and cusp extension are described. Methods for intraoperative evaluation of the repaired valve are also described. Between August 1988 and April 1992, 166 patients underwent aortic valve reconstruction with a 3.2% hospital and 1.2% late mortality. There were no thromboembolic events in the patients with isolated aortic valve repair. The reoperation rate was 6.5%. Echocardiographic study at last follow‐up showed stable results at 4 years maximum follow‐up. (J Card Surg 1993; 8:443

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1993.tb00392.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

AbstractIn recent years, the use of homograft tissue in cardiac surgery has increased so that supply is limited. Since October 1990, aortic and/or pulmonary valves were collected from 17 transplant recipients at the Department of Cardiovascular Surgery of the University of Padova Medical School (11 male, 6 female, mean age 43.4 years, range 11 months to 61 years). The indications for transplant were dilated cardiomyopathy in 7, and end‐stage ischemic heart disease in the remaining 10 patients. Twelve such valves have been subsequently reimplanted either as fresh or as cryopreserved valved homografts in the repair of different forms of congenital heart disease, by means of different tailoring techniques (7 male, 5 female; mean age 4.8 years [range 1 day to 18 years]; transposition of the great arteries = 5 cases; tetralogy of Fallot = 3 cases; hypoplastic left heart syndrome = 2 cases; double outlet right ventricle = 1 case; truncus arteriosus = 1 case). Overall, early mortality was 25%. None of these deaths could be related to the use of homografts. There have been no instances of valve related complications among nine patients surviving surgery at a mean follow‐up of 11 months. All patients having heart explanted should be regarded as potential sources for aortic and pulmonary homogra

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1993.tb00393.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

AbstractThe continuous suture technique has been proposed as an alternate method for aortic valve replacement (AVR). Advantages include a decreased ischemic and bypass time. Despite reports of a low incidence of perivalvular leak, wide use of the continuous suture technique has not been adopted. This report reviews our experience with the continuous suture technique. From January 1984 through November 1991, 181 consecutive patients underwent AVR using the continuous suture technique. The mean age was 61 years (range 6 to 88 years). Diagnoses included pure aortic stenosis (AS) in 41%, aortic insufficiency (Al) in 31%, and a combination of AS and Al in 28%. Fifty‐six patients underwent isolated AVR and 125 underwent AVR combined with other procedures. The overall early mortality was 5.5%. Early mortality for isolated AVR was 0% (0/56) and was 8.0% (10/125) for those undergoing concomitant procedures. Late mortality was 4.7% in a mean follow‐up of 30 months (range 1 to 86 months). The incidence of perivalvular leak was 2.3% (4/171 operative survivors). Perivalvular leak was mild in two, and moderate in two; none required reoperation. Perivalvular leak developed only in patients whose suture line was not reinforced with glutaraldehyde treated pericardium. The continuous suture technique is a quick and effective method for AVR and results in a low incidence of perivalvular l

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1993.tb00394.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

AbstractThe problem of early onset aortic insufficiency as seen with the scalloped, sub‐coronary homograft aortic valve replacement is reduced with the use of a total root replacement. In addition, the naturally competent aortic root is more durable. From September 1985 to April 1991, 26 consecutive patients underwent aortic root replacement with 10 autografts, 14 homografts, and 2 xenografts using a modified implantation method. Twenty‐five patients were discharged from the hospital. This partial inclusion root technique for implanting unstented valves in the aortic position decreases the probability of early failure secondary to technical malalignment at the time of implantation. In contrast to total root replacement, it avoids the need to destroy the recipient aortic root. A longitudinal aortotomy is performed to the aortic annulus in the mid‐portion of the noncoronary sinus. The proximal suture line is interrupted with the valve oriented in the anatomical position. Circumferential running monofilament side‐to‐side anastomoses approximate the donor coronary ostia to the recipient. A running medial and lateral posterior suture line to the lateral superior portions of the aortotomy completes the integrity of the anterior wall of the implantation. One autograft attempt failed and one homograft patient died postoperatively. Follow‐up ranges from 1 to 6 years in 24 patients. Postoperative aortic insufficiency was significant in one case due to inappropriate sizing of the proximal aortic suture line. There has been no evidence of progressive aortic insufficiency detected by the early onset of diastolic murmurs or echocardiograms as was our previous experience with the scalloped subcoro

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1993.tb00395.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

AbstractMitral and aortic valve rings were radically enlarged in a 70‐year‐old white female presenting with unusually tiny and severely stenotic rheumatic mitral and aortic valve disease. A common aorto‐left atrial incision created by cutting across the two valves made it possible to implant adequate size St. Jude valves. The resulting defect in the roof of the left atrium and the aortic root were closed with a generous patch of polytetrafluoroethylene (PTFE). The center of the patch and the unattached segments of the two prostheses were incorporated with interrupted horizontal mattress su

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1993.tb00396.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

AbstractAn increasing number of patients with advanced coronary artery disease and diffusely complex atherosclerotic lesions are referred for coronary artery bypass surgery (CABG). Under these circumstances, complete myocardial revascularization with an adequate distal runoff can only be achieved by extensive manual endarterectomy and a reconstructive procedure prior to conduit placement. Because of the numerous septal and diagonal branches of the left anterior descending artery (LAD), an extended and meticulous endarterectomy is warranted. Placement of the internal mammary artery (IMA) on such a widely opened vessel requires reconstruction with a vein patch and the IMA. A modified technique of extended manual endarterectomy, distal vein patch, and proximal IMA reconstruction and revascularization is described. This technique was used in six patients between October 1990 and December 1992 with 100% early survival. This technique is less time consuming and more importantly allows for a direct artery‐to‐artery anastomosis with the potential for a better long‐term pa

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1993.tb00397.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

AbstractOver a period of 11 months, 38 patients submitted to coronary artery revascularization underwent intraoperative angioscopy of the coronary arteries and internal thoracic arteries. Fifty‐nine lesions were observed, but only 31 stenoses responsible for coronary insufficiency were observed (33%). Forty‐four distal anastomoses were explored (47%) but ten of these explorations were incomplete. None revealed technical failure of the anastomosis. Thirteen harvested left internal mammary arteries were explored. One of the explorations led to rejection of the graft due to an intimal fracture. Some tiny intimal flaps were observed in our experience, as in others. Although the iatrogenic origin of these lesions in relation to the introduction of the angioscope is obvious, it does not seem to influence the outcome of the operation. In our opinion, two main fields appear to be developing in coronary angioscopy: preoperative assessment of the quality of internal thoracic artery grafts, and control of distal graft anastomoses. The flexibility of the angioscopes and of the leading catheters must be improved to minimize the risk of arterial wall traumatic lesions. (J Card Surg 1993; 8:483

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1993.tb00398.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

AbstractA technique is described for aortic augmentation with Dacron mesh coated pericardial patch. This method avoids the use of synthetic graft material with the potential for weak adherence of pseudointima and microembolization. Hemostasis is improved and fibrous tissue ingrowth into the mesh prevents late aneurysm formation. The incorporation of the pericardial patch into the aortic wall and the normal endothelialization of the patch is documented after a 5‐year follow‐up. (J Card Surg 1993; 8:488

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1993.tb00399.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

AbstractRemarkable strides have been made in perioperative myocardial protection for heart operations. Recent advances in understanding the physiology of myocardial ischemia and its protective responses suggest that there is a possibility for further improvement. Some of these strategies are discussed in this article, which updates current thinking in regard to operative developments contributing to myocardial protection, preconditioning, inhibition of adenosine triphosphate catabolism, the critical role of adenosine, management of myocardial edema, antioxidant therapy, endothelial cell injury, and the interaction between activated leukocytes and the endothelium. Some potential new directions for cardioprotection are identified. (J Card Surg 1993; 8:492–50

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1993.tb00400.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY