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Biomedical subjects

F Simonet

Publications and source records attributed to F Simonet.

At least 37 records · Page 2Linked to original sources
PubMed1996

Adult respiratory distress syndrome after cardiac surgery.

Adult respiratory distress syndrome, characterized by high permeability pulmonary oedema caused by endothelial cell damage, resulting in refractory hypoxemia, has a very high mortality. Cardiopulmonary bypass is said to be responsible for the development of adult respiratory distress syndrome after cardiac surgery. The present study was performed in order to identify predicting and aetiological factors of adult respiratory distress syndrome and multiple organ failure after cardiac surgery. Between January 1984 and December 1993, 3848 patients underwent cardiac surgery with cardiopulmonary bypass in the authors' institution, and were analysed in a retrospective manner. The operations performed were 3444 coronary artery bypass grafts (CABG), 267 valve and 137 combined (CABG + valve) procedures. The incidence of adult respiratory distress syndrome was 1.0% (38 of 3848) with an overall mortality rate of 68.4% (26 patients); 24 of these died from multiple organ failure. Multivariate regression analysis identified hypertension, current smoking, emergency surgery, preoperative New York Heart Association (NYHA) class 3 and 4, low postoperative cardiac output and left ventricular ejection fraction < 40% as significant, independent predictors for adult respiratory distress syndrome. Combined cardiac surgery and diffuse coronary disease were also significant predictors; cardiopulmonary bypass time was not. Thirty-six of the 38 patients that later developed adult respiratory distress syndrome had low postoperative cardiac output, 12 requiring intra-aortic balloon pump support. The remaining two had severe hypotension caused by postoperative bleeding. Twenty-six adult respiratory two had severe hypotension caused by postoperative bleeding. Twenty-six adult respiratory distress syndrome patients (68%) had confirmed gastrointestinal complication (e.g. intestinal ischaemia). Adult respiratory distress syndrome is a rare complication after cardiac surgery but is associated with a very high mortality. Preoperative predictors were identified. Cardiopulmonary bypass alone was not found to be an important factor. Postoperative low cardiac output leading to splanchnic hypoperfusion may be the most important single factor in developing adult respiratory distress syndrome after cardiac surgery.

Adult↗
PubMed1996

The impact of a short interval ( < or = 1 year) between primary and reoperative coronary artery bypass grafting procedures.

Reoperative (redo) coronary artery bypass grafting is an efficient treatment for patients with progressive coronary artery disease and those with conduit failure. Previous studies have demonstrated that a short time interval between primary and redo coronary artery bypass grafting is associated with a significantly higher mortality rate. In the present report this particular group have been specifically evaluated. Between 1 January 1990 and 1 October 1994, 383 consecutive patients underwent redo coronary artery bypass grafting. Thirty-three patients (8.6%) were operated on at < or = 1 year (group 1) and 350 patients at > 1 year after the primary bypass (group II). The main indications for redo in group I were graft failure (58%), incomplete revascularization (39%) and progress of disease (3%); respective values in group II were 26% 15%, and 23%. In addition, 36% of patients in group II had combinations of complications. Patient characteristics did not differ between groups, except a higher incidence of insulin-dependent diabetes in group I (P < 0.05). There was a higher incidence of left main stem stenosis of > 70% in group I (P < 0.05). Group I patients had a longer aortic cross-clamping time and needed thromboendarterectomy and patching of coronary vessels more often than did those in group II (P < 0.05). The internal mammary artery had been more frequently used at the primary coronary artery bypass grafting in group I (P < 0.01). The overall mortality rate was 8.9%; that in group I was 18% and in group II, 8% (P < 0.05). There was a higher incidence of non-fatal myocardial infarction and a need for prolonged ventilatory support (> 24 h) in group I. Other postoperative complications did not differ. Significant risk factors for mortality in group I were preoperative Canadian Cardiovascular Society class > or = 3, unstable angina, need for urgent operation and left ventricular ejection fraction < 40%, and > or = 70% left main stem stenosis. In group II, the risk factors were: unstable angina, urgent operation, left ventricular ejection fraction < 40%, internal mammary artery not used at primary coronary artery bypass grafting and the need for coronary thromboendarterectomy. The 3-year survival and cardiac event-free survival did not differ between the groups. This study has confirmed that early redo coronary artery bypass grafting (< or = 1 year from primary bypass) is associated with an increased operative risk.

Coronary Artery Bypass↗
PubMed1996

Open chest and delayed sternal closure after cardiac surgery.

OBJECTIVES: Open chest (OC) and subsequent delayed sternal closure (DSC) has been described as a useful method in the treatment of the severely impaired heart after cardiac surgery. METHODS: Prolonged open chest was used in 142 to 3373 adult cardiac operations (4.2%) between January 1987 and December 1993. The indications were: hemodynamic compromise (121), intractable bleeding (9) and arrhythmias (12). Delayed sternal closure was carried out in 123 of 142 patients at a mean of 2.0 +/- 1.4 days (range 0.5-8 days). Open chest and DSC were used proportionally more frequently after combined cardiac surgery (28/293, 9.6%) than after coronary artery bypass grafting (CABG) alone (108/2891, 3.7%) or valve operation (6/230, 2.6%). RESULTS: Ninety-seven of the 123 who had DSC (78.9%) survived and were discharged an average of 8.6 +/- 4.2 days after closure. Fourty-five patients died: 19 before DSC and 26 after this method. Mortality was related to indications for OC: when the indication was low cardiac output the mortality was 38.6%, for hemodynamic collapse on closure 0%, diffuse bleeding 33.3% and arrhythmias 27.3%. Delayed sternal closure in patients without intraaortic balloon pump support was more likely to be successful (mortality rate 4/25, 16.0% versus 35/76, 46.3%, P < 0.01). Superficial sternal wound infection occurred in 2 of 123 (1.6%) patients after DSC, mediastinitis in 1 (0.8%) and sternal dehiscence in 3 (2.4%) patients, which does not differ from a control population that had primary sternal closure. The follow-up of 97 survivors at an average of 28 +/- 4 months revealed an improvement of NYHA class by 1.4 +/- 0.4. There were 16 deaths (13 cardia-related) during the follow-up period and 3 redo CABG. One case of sternal osteomyelitis occurred without any other late sternal morbidity. CONCLUSIONS: This study shows that OC with DSC is a beneficial adjunct in the treatment of postoperatively impaired cardiac function, profuse hemorrhage and persistent arrhythmias. It can be performed without increased sternal morbidity. Long-term results are also encouraging.

Adult↗
PubMed1996

Autologous platelet sequestration in patients undergoing coronary artery bypass grafting.

OBJECTIVES: Blood conservation remains an important issue for patients undergoing cardiac surgery with cardiopulmonary bypass. Platelet sequestration (PSQ) is an aggressive autologous blood conservation method, whose effectiveness is still debated. The main objective of the present study was to evaluate whether PSQ reduces postoperative blood transfusion requirements in patients undergoing coronary artery bypass grafting (CABG) and to determine if PSQ is a cost-effective blood conservation method. MATERIAL AND METHODS: All adult patients admitted for CABG entered the study. Exclusion criteria were: recent blood transfusion (<7 days), a platelet count of 150x10(3)/microl or less, hematocrit less than 35% and body weight 50 kg or less. The sequestration was aim 20% or more of the total platelet plasma volume. The sequestration protocol was three sequestration cycles performed just prior to surgery. The concentrated platelet portion was reinfused after weaning from the cardiopulmonary bypass. Hundred seven parameters/patients were recorded. Sixty patients entered the study; 30 in the PSQ group and 30 controls (CTR). RESULTS: Patient characteristics, operation data, preoperative hematology and coagulation parameters did not differ between the groups. In the PSQ group a mean of 433+/-34 ml concentrated platelet portion was collected. The mean platelet count in the concentrated platelet portion was 749+/-157x10(3)/microl, resulting in a platelet yield of 28+/-6% (2040%). The average total chest tube blood loss was 423 ml (PSQ) compared to 858 ml (CTR), p<0.001. A greater number of CTR patients required blood transfusion postoperatively (23) compared to PSQ (3), P<0.001, and fluid requirements were also significantly increased in the control group, P<0.001. No statistical differences in hematology and coagulation parameters between the groups were observed. The hospital mortality was low and the incidence of postoperative complications was few and without group differences. Post-extubation gas exchange was better in PSQ patients compared to CTR. CONCLUSIONS: A preoperative PSQ of a minimum 20% of the total platelet plasma volume resulted in significantly lower postoperative blood loss and fluid and blood transfusion requirements compared to controls. Post-extubation gas exchange was also better after PSQ. Only one patient did not tolerate the sequestration. No other adverse effects of the procedure were observed.

Adult↗
PubMed1996

The impact of arterial hypertension on the results of coronary artery bypass grafting.

Arterial hypertension is though to be associated with reduced coronary vasodilator reserve in the coronary microcirculation. Increased ventricular mass and coronary arteriolar abnormalities are the dominant features in patients with severe hypertension, while large-vessel coronary disease is the predominant feature in patients with mild hypertension. In the present study we have evaluated how hypertension influences the outcome of coronary artery bypass grafting (CABG), with emphasis on patients with preoperative left-ventricular ejection fraction (LVEF) < or = 25%. Between January 1, 1990 and November 1, 1994, 77 consecutive patients with LVEF < or = 25% (Hypertensive, n = 38 [group I] and normotensive, n = 39 [group II] underwent CABG. During the same time period 2289 patients with LVEF > 25% underwent CABG (Hypertensive, n = 870 [group III] and normotensive, n = 1419 [group IV]) and were studied for comparison. Mean age (64 years), sex distribution (86% men), and other classical risk factors did not differ between the groups, except a higher incidence of insulin-dependent diabetes in patients with LVEF < or = 25%. There were 18% reoperative CABG, 91% of the patients were Canadian Cardiovascular Society's (CCS) angina class 3 and 4 preoperatively, 38% had unstable angina, and 35% underwent urgent surgery (within 24 hours of admission). Angiography and operation data did not differ significantly between the groups. Hospital mortality in group I was 5.3% and in group II 15.4%, p < 0.008. In group III it was 6.3% and in group IV 2.2%, p < 0.001. Postoperative low cardiac output occurred in 18% (group I) and 39% (group II), p < 0.05, and only in 5% in groups III and IV, p < 0.001. Non-fatal myocardial infarction and other postoperative complications revealed no group differences. LVEF and CCS class improved from 1 month postoperatively in groups I and II, however, significantly more in group I (hypertensives), p < 0.001. Hypertensive patients with poor left-ventricular function preoperative to were found to have a lower hospital mortality and incidence of postoperative low cardiac output than normotensiven with LVEF < or = 25%. Hypertensive patients also had a better improvement of their left-ventricular function and CCS class than normotensiven. Left-ventricular hypertrophy and previous myocardial infarction were predictors for mortality in patients with LVEF > 25%. Patients with LVEF < or = 25% showed the same tendency, though not statistically significant.

Adult↗
PubMed1996

[Should heart surgery and thromboendarterectomy of the carotid artery be done simultaneously?].

The management of patients with coexisting severe carotid and coronary artery disease continues to be controversial. To evaluate the actual risks we have reviewed our experience of 92 patients that underwent simultaneous cardiac surgery and carotid thrombendarterectomy (TEA) over a 10 year period. The mean age was 65 +/- 7 year (41-80), 75% were men. There were 11 REDO cardiac procedures. There were 15 symptomatic and 77 asymptomatic carotid artery stenosis, including 21 with bilateral carotid disease. Mean preop.LVEF was 57.4% (15-80%). Carotid TEA was performed under hypothermia (26 degrees C), preferably with beating heart after an equilibration period of 10 min. The overall mortality was 5.4% (5 patients). 4 of the deaths were reoperative cardiac surgery. Non-fatal myocardial infarction occurred in 1 patient. Postop. neurological complications were diagnosed in 7 patients (8%), 3 transient and 4 permanent neurological deficits occurred. 33 patients had no post-operative complications at all and 25 patients had as only complication, transient arrhythmia. Follow-up revealed a 5-year survival rate of 83% and a cardiac event-free survival of 70%, without neurological events. We therefore conclude that simultaneous carotid TEA and cardiac surgery can be performed using controlled hypothermic cardiopulmonary bypass (26 degrees C), in experienced hands, with an acceptable mortality (5.4%) and low morbidity. Carotid TEA combined with two or more cardiac procedures has the highest mortality and morbidity and should be avoided.

Adult↗
PubMed1996

Reactive thrombocytosis following coronary artery bypass surgery: a possible link to a lipid dysfunction.

Reactive thrombocytosis (RT, Platelet counts >400x10(3)/mm3) following coronary artery bypass grafting (CABG) has earlier been described to occur frequently (20%) and is associated with thrombotic complications eg. vein graft occlusion. This prospective study was undertaken in an attempt to identify the underlaying causes of RT following CABG. Fourty consecutive patients undergoing elective CABG entered the study, between December 1, 1994 and April 15, 1995. Patient characteristics, operation data, cardiopulmonary data and postoperative complications (30 parameters) were entered into a database together with routine blood chemistry and hematology results, hemostasis and antiinflammatory (eg.IL-6) parameter (25 parameters/day), preoperatively until the 9th postoperative day. Fifteen patients developed RT and the remaining 25 served as controls (C). Fourteen patients, chosen at random, received Aspirin, 100 mg daily, starting from the 3rd postoperative day, all patients were anticoagulated postoperatively with heparin and later coumarine. Patient characteristics, except a larger number of patients with hyperlipidemia in the RT group, did not differ. Operation data, cardiopulmonary bypass data as well as postoperative complications revealed no group differences, neither did preoperative laborations, except that S-Cholesterol was higher in the RT-group, 6.2+/-0.9 vs 5.3+/-0.9, p<0.018. All blood laborations were without group differences throughout the entire study period, except platelet counts, platelet size (PWD) and mean platelet volume (MPV), and AT III levels at the 7th postoperative day, which was significantly lower in controls compared to RT. RT patients had a less marked drop in platelet count immediately after cardiopulmonary bypass than non-RT together with an increased MPV, but without differences in the PWD. There was a significantly higher platelet count in the RT-group on the 3rd postoperative day, which remained higher throughout the study period and RT was established on the 7th postoperative day. Additional treatment with Aspirin postoperatively did not influence studied parameters. This study has again found RT frequently occurring after CABG (30%). It was found that the preoperative S-Cholesterol level was significantly higher in the RT group, while hemostasis and anti-inflammatory parameters did not differ RT vs non-RT. It could therefore be possible that RT is linked to a lipid dysfunction and further studies are on-going.

Adult↗
PubMed1996

[Surgical correction of the ventricular geometry in post-infarction left ventricular aneurysms].

Left ventricular aneurysm (LVA) following myocardial infarction carry a high morbidity and mortality, which may be reduced by appropriate surgical treatment. The Jatene correction is an attractive technique for aneurysm repair. We have employed a modified Jatene correction in 72 patients between July 1986 and May 1995. There were 57 men and 15 women, mean age 61.6 +/- 8.2 years old. Fifteen patients (21%) presented with malignant recurrent ventricular arrhythmias. Fourteen patients had emergency operations and 3 were redo coronary artery bypass grafts. Fifty-eight patients (83%) were in NYHA class III and IV. Fifty-two patients had 3-vessel disease. Preoperative left ventricular ejection fraction (LVEF) was 30.4 +/- 12.2% (10-59%) and left ventricular end-diastolic pressure was 26.2 +/- 10.1 mmHg (12-41 mmHg). The overall perioperative mortality was 11.1%, one patient had a peroperative myocardial infarction. Immediately postoperatively, 17 patients had low cardiac output, requiring intraaortic balloon pump in eight cases. There were no bleeding problems and 30 patients (42%) had no postoperative complications whatsoever. The average hospital stay was 10.2 days. Left ventricular cavity size, measured (echocardiography) showed significant reduction 1 week postoperatively, which was unchanged after 1 month. The left ventricular ejection fraction was significantly increased 1 month postoperatively. After follow-up, on average 20 months, there was significant improvement in mean NYHA class. The modified Jatene correction of left ventricular aneurysm is simple, carries acceptable mortality and low morbidity and significantly improves left ventricular function.

Aged↗
PubMed1995

Risks, benefits and results of reoperative coronary surgery with internal mammary grafts.

To determine the effect of a prior internal mammary artery graft on coronary artery bypass reoperation, experience with 189 consecutive patients who underwent such surgery was reviewed. Some 147 patients (group I) received only saphenous vein grafts at the primary coronary bypass surgery (CABG) and 42 (group II) received at least one IMA graft at the primary CABG. There were no differences in preoperative patient characteristics or operative data between the groups. Significantly more redo CABG 0-5 years after the initial operation was seen in group II compared with that in group I, indicating inadequate first operation or technical difficulties. In group II a larger proportion of the patients had patent grafts at redo (52.4% versus 34.7%). There were no entry injuries to the grafts or the heart in either group. No operative mortality was encountered in group II, while seven patients in group I died (P < 0.05). Group II had more pneumonia (P < 0.01) and re-exploration for bleeding (P < 0.001) than group I. However, the overall postoperative morbidity in group II patients was less than in group I, though not statistically significant. When comparing patients with an occluded internal mammary artery graft at redo (group A) with those who had a patent internal mammary artery graft (group B) there were no statistically significant differences in patient characteristics and preoperative patient profile, even though group B patients showed a trend towards a better preoperative cardiac profile. A mean of 2.4 grafts/patient were performed in group B compared with 4.0 in group A (P < 0.01). Other operative parameters did not differ between the groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

Normothermic versus hypothermic perfusion during primary coronary artery bypass grafting.

Normothermic versus hypothermic cardiopulmonary bypass was evaluated in 1442 consecutive patients undergoing primary coronary artery bypass grafting (CABG). Group 1 (n = 545) were operated on in moderate systemic hypothermia (rectal temperature 28 degrees C) and group 2 (n = 897) in normothermia (rectal temperature 37 degrees C). Both groups had cold cardioplegic arrest (10 degrees C) and local cooling of the heart with slush. Anaesthesia and operative techniques were identical in both groups. The mean age was 60 years; group 2 contained significantly more patients aged > 65 years (P < 0.05) and had more frequent emergency operations (P < 0.001) than group 1. Other preoperative patient characteristics were similar between groups. Aortic cross-clamping time was similar in both groups but cardiopulmonary bypass time was significantly longer in group 1 than in group 2 (97.9(28.8) versus 76.6(26.0) min, P < 0.001). Perioperative mortality rate was 3.3% in group 1 and 2.6% in group 2. The incidence of myocardial infarction was significantly higher in group 1 than in group 2 (2.0% versus 0.7%) Perioperative low cardiac output needing inotropic support was similar in both groups, but group 1 patients required more intra-aortic balloon insertions (4.6% versus 2.2%, P < 0.05). Lower incidence of postoperative ventricular arrhythmias, shorter intubation time and less transient renal failures were significant in group 2 compared with those in group 1 (P < 0.001), while re-exploration of bleeding, wound infections, pulmonary, neurological and gastrointestinal complications did not differ. Blood transfusion was less in group 2 (1.2(1.1) units, P < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

Reactive thrombocytosis after coronary bypass surgery. An important risk factor.

Reactive thrombocytosis (RT) has earlier been reported to occur as a response to various situations and conditions, such as post-splenectomy, hematopoietic disorders, major trauma and operations, neoplasms and inflammations. In cardiac surgery the main interest has focused on thrombocytopenia that occurs after cardiopulmonary bypass (CPB) and the risk of postoperative bleeding, rather than the possibility of a late occurrence of RT as a risk factor for thrombotic complications after coronary artery bypass grafting (CABG). Between 1989 and 1992, on routine blood examinations we noticed a group of CABG patients (n = 297, Group II, 19.5%) that, 1 week after operation, showed thrombocytosis with significantly increased platelet count (521 +/- 96 x 10(3)/mm3) compared to patients with normal platelet counts (Group I, n = 1521, 185 +/- 125 x 10(3)/mm3); P < 0.001. Patient characteristics, coronary angiography findings, operative data and perioperative complications were analyzed for the two groups. There were significantly more patients with hyperlipidemia, smoking and previous myocardial infarction in Group II than in Group I; P < 0.05. Age, sex, clinical characteristics, angiography findings and operative data did not differ between the groups. There were no differences in postoperative bleeding or the need of transfusion between the groups. However, Group II (RT) patients had significantly more postoperative myocardial infarctions, 4.4% compared to 0.7% Group I; P < 0.001. Early symptomatic vein graft occlusion (0-7 days postoperatively) was not different between the groups, while there were significantly move late symptomatic vein graft occlusions (7-60 days postoperatively) in Group II (RT) 4.4% than in Group I 1.1%; P < 0.001.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

The intraaortic balloon pump for postcardiotomy heart failure. Experience with 169 intraaortic balloon pumps.

The intraaortic balloon pump (IABP) is usually the first mechanical device inserted for perioperative heart failure. In the present study we have reviewed our experience with 169 IABP insertions with emphasis on IABP complications, route of insertion, and identification of predictors of mortality. Between January 1, 1984 and March 31, 1993 3,591 adult patients underwent cardiac surgical procedures, 169 of whom (4.7%) had an IABP inserted preoperatively (7 patients, 4.1%), intraoperatively (109 patients, 64.5%), or postoperatively (53 patients, 31.4%). There were 137 men (81.1%) and the mean age was 60.2 +/- 8.8 years (28-78 years). Operations included 149 coronary bypass grafting (CABG) (4.6%, 149/3,209), 6 valve replacements, single or double (2.4%, 6/255), and 14 valves combined with CABG (11.0%, 14/127). The IABP was used more frequently in reoperations (14.8%, 80/542), compared to primary operations (2.9%, 89/3,049), p < 0.001. It was also more frequently used after emergency operations (50.7%, 39/77), than after elective operations (3.7%, 130/3,514), p < 0.001. In 119 patients femoral insertion was performed (13 percutaneously and 106 surgically), while 50 patients had an intraaortic insertion. The mean duration of IABP support was 50 hours (0.5-576 hours). There were 8 (4.7%) complications related to the balloon pump, all after femoral insertion (3 after transcutaneous and 5 after surgical insertions). Six of the complications occurred when the IABP was inserted intraoperatively and 2 postoperatively. The complications were 7 cases of leg ischemia (88%) and 1 groin wound infection.(ABSTRACT TRUNCATED AT 250 WORDS)

Cardiac Surgical Procedures↗
PubMed1995

Is reoperative coronary artery bypass grafting in patients with poor left ventricular ejection fractions < or = 25% worthwhile?

AIM: This study aimed to investigate whether patients with very low left ventricular ejection fractions (LVEF) should be accepted for reoperative coronary artery bypass grafting (CABG). STUDY POPULATION: Between January 1990 and December 1993, 1681 patients underwent primary CABG and 308 (15.5%) reoperative CABG. One hundred and eight patients (5.4%) had an LVEF < or = 25%, 91 patients for primary CAGB (group I) and 17 for CABG (group II). The mean age of the patients was 62 years. Sex distribution and preoperative risk factors did not differ. Urgent operations were more frequently necessary in group II (P < 0.01). Mitral regurgitation was present in 49% of the group I patients and 18% of the group II patients (P < 0.05). Pulmonary artery hypertension was observed in 24% of group I patients, but in only 6% in group II patients. The mean LVEF was 21% and left ventricular end-diastolic pressure 18 mmHg, without between-group differences. All patients had significant two- or three-vessel disease (stenosis > or = 70%). An average of 4.5 grafts per patient were performed. Mitral valve surgery was not performed in any of the patients. RESULTS: The postoperative mortality was significantly higher in reoperative CABG patients (group II; 23.5%) than in group I patients (12.1%; P < 0.05), whereas the incidence of non-fatal myocardial infarction did not differ. The incidence of postoperative complications did not differ between the groups, except for transient renal failure, more frequently encountered in group II (P < 0.05). After an average follow-up of 18 months, the New York Heart Association (NYHA) class and the LVEF were significantly improved in both groups (NYHA class from 3.5 to 1.8 and LVEF from 21% to 45%; P < 0.001). The mitral regurgitation had improved or completely disappeared at the end of follow-up in all patients in both groups. CONCLUSIONS: Our results suggest that patients with left ventricular ejection fraction < or = 25%, angina and significant two- or three-vessel coronary artery disease should not categorically be refused for reoperative CABG. Careful patient selection is necessary because of an increased operative risk.

Case-Control Studies↗
PubMed1995

Preoperative diagnosis of a pulmonary artery sarcoma.

A pulmonary artery sarcoma was diagnosed preoperatively by magnetic resonance imaging enhanced with gadolinium and confirmed by percutaneous computed tomographic guided needle biopsy. Accurate preoperative diagnosis allowed planned curative surgery with removal of the right ventricular outflow tract and reconstructive surgery using a cryopreserved homograft.

Adult↗
PubMed1995

Jatene correction of the ventricular geometry in postinfarction left ventricular aneurysm. Results of 62 operations.

Jatene correction of left ventricular aneurysm was performed on 62 patients (including 11 emergency operations) with mean age 60 years, 80% of them in NYHA class 3-4, with mean left ventricular ejection fraction c. 30%and mean left ventricular end-diastolic pressure c. 24 mm. Concomitant bypass grafting was performed in 58 cases (mean grafts per patient 3.7). Perioperative mortality was 12.9%. One patient had peroperative myocardial infarction. Postoperatively 13 patients had low cardiac output, requiring intra-aortic balloon pump in seven cases. There were no bleeding problems and 28 patients (45%) had no postoperative complications. The average hospital stay was 10.2 days. Left ventricular cavity size (echocardiography) showed significant reduction 1 week postoperatively, which was unchanged after 1 month. The left ventricular ejection fraction was significantly increased 1 month postoperatively. After follow-up averaging 15 months there was significant improvement in mean NYHA class. One patient underwent heart transplantation and died, but there were no other late deaths or cardiac-related complications. Jatene correction of left ventricular aneurysm is simple, carries acceptable mortality and low morbidity and significantly improves left ventricular function.

Echocardiography↗
PubMed1995

Mitral regurgitation in patients with coronary artery disease and low left ventricular ejection fractions. How should it be treated?

In recent years, coronary artery bypass grafting has been extended to include patients with very low left ventricular ejection fractions. Should concomitant mitral valve regurgitation be corrected simultaneously? Between January 1990 and July 1994, 43 patients with preoperative left ventricular ejection fractions < or = 25% and echocardiographic evidence of concomitant mitral valve regurgitation (grade I, 18 patients; II, 19 patients; and III, 6 patients) underwent primary coronary artery bypass grafting. None of these patients underwent simultaneous mitral valve surgery. Twenty-four patients (56%) had pulmonary artery pressures > or = 40 mmHg (pulmonary hypertension). The mean preoperative left ventricular ejection fraction was 18.7% +/- 4.4% (range, 10% to 25%), and the mean pulmonary artery pressure was 45.6 +/- 15.8 mmHg. The average of number of grafts per patient was 4.5 +/- 1.5. Five patients underwent simultaneous repair of a left ventricular aneurysm. The hospital mortality rate was 4.7% (2/43). Transient low cardiac output occurred postoperatively in 13 patients (30%). Sixteen patients (37%) had no postoperative complications. The average follow-up of the 41 hospital survivors was 6 months (range, 1 to 32 months). One patient died 8 months after surgery for an overall mortality rate of 7%. Another 2 patients had graft occlusions that did not require reoperation. In the 40 surviving patients, follow-up echocardiography revealed that 37 patients (93%) had either no mitral valve regurgitation or only very mild mitral valve regurgitation (grade I). Three patients had grade II mitral valve regurgitation, but none required mitral valve surgery. The New York Heart Association functional class improved significantly in all hospital survivors (from 3.4 +/- 0.6 to 1.7 +/- 0.7; p > 0.001), and left ventricular ejection fractions rose from 19.0% +/- 4.6% to 42.0% +/- 8.3%. Coronary artery bypass grafting is possible in patients with very low left ventricular ejection fractions who present with 2- or 3-vessel disease, significant coronary artery stenoses (less than or equal 70%), and angina. The mortality rate is acceptable and morbidity is low. If there is no rupture of papillary muscle or chordae, concomitant ischemic mitral regurgitation (grades I through III) seems to return to normal after coronary artery bypass grafting and, therefore, does not need to be corrected surgically during the primary operation.

Adult↗
PubMed1995

Effect of low left ventricular ejection fractions on the outcome of primary coronary by-pass grafting in end-stage coronary artery disease.

Advanced ischemic heart disease (HID) with very low left ventricular ejection fraction (LVEF), pulmonary hypertension (PHT) with or/without left ventricular aneurysm (LVA) are criteria for defining end-stage coronary artery disease (ESCAD). Coronary artery by-pass grafting is often denied to these patients. Between January 1990 and December 1993, 91 patients with ESCAD, significant 2 or 3-vessel disease (stenosis > or = 70%) and LVEF < or = 25% underwent primary CABG at our institutions. The mean age was 62.5 +/- 8.0 years (41-81), 89% were men. Eighty-one patients were in preoperative NYHA (New York Heart Association) functional class 3 and 4. Mean LVEF was 21.3 +/- 3.8% (10-25). Mitral regurgitation (MR) was present in 39/91 (43%). The systolic pulmonary artery pressure (PAP) was 33.2 +/- 17.1 mmHg (11-75) and the wedge pressure was 19.0 +/- 10.8 mmHg (5-47). Twenty-two patients had significant PHT with a systolic PAP > or = 40 mmHg. The overall perioperative mortality was 14.3% (13/91). Low postoperative cardiac output occurred in 33 patients, requiring intraaortic balloon support in 13. Gastrointestinal complications occurred in 6 patients and neurological events in one. Fifteen patients had additional left ventricular aneurysm repair. There was a good correlation between LVEF and PAP (r = 0.782). Surprisingly, in a subset of patients with preoperative PHT and LVEF < or = 25% the mortality rate was only 4.6% (1/22). Other perioperative complications did not differ.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗