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Biomedical subjects

L G Svensson

Publications and source records attributed to L G Svensson.

At least 19 recordsLinked to original sources
PubMed2001

Elephant trunk anastomosis between left carotid and subclavian arteries for aneurysmal distal aortic arch.

There is an increased risk of rupture with attempting a distal anastomosis when the distal aortic arch exceeds 5 to 6 cm. To circumvent this problem, we describe performing the anastomosis between the left common carotid and the left subclavian arteries and, at the second-stage operation, interposing a tube graft between the left subclavian artery and the descending aortic tube graft.

Anastomosis, Surgical↗
PubMed2001

Minimal access aortic surgery including re-operations.

OBJECTIVES: Safety and benefits of minimal access ascending aorta and aortic arch surgery, including for re-operations has not been reported. METHODS: Fifty-four patients undergoing minimal access operations were evaluated. Of the 54 patients, valve replacements were performed in 76% (41 patients) (including composite valve grafts), and re-operations in 33% (18 patients). Composite valve grafts were used in 28% (15 patients) patients, and elephant trunk type procedures in 6% (three patients). RESULTS: The survival rate was 96% (52 patients), stroke 3.7% (two patients), and neurocognitive deficit 1.8% (one patient). The circulatory arrest time was 20 min (SD 17), aortic crossclamp time 91 min (SD 45) and cardiopulmonary bypass time 132 min (SD 59). Intraoperative homologous blood transfusion was a mean of 1.3 units (SD 2.3). ICU and postoperative stay were 1.8 days (SD 1.9) and 6.7 days (SD 3.7), respectively. No patient died after re-operation, although one patient had a stroke. CONCLUSIONS: Minimal access aortic surgery does not appear to carry a greater risk and, although more demanding technically, is associated with a reasonable ICU and hospital stay. For re-operations, we particularly recommend the technique.

Adult↗
PubMed2000

Management of aortic valve disease during aortic surgery.

BACKGROUND: Alternative management strategies for aortic valve disease and aortic operation include valve preservation and aortic repair (VPR), composite valve graft (CVG), or separate valve and aortic repair (SVR). We evaluated these approaches. METHODS: Of 250 ascending/arch operations, 151 patients had aortic valvular disease and dissection (n = 56, 37%) or aneurysms operated between November 1990 and January 1998. Sixty-seven patients underwent CVG insertion, 50 SVR, 13 VPR, and 21 only aortic repair alone (RA). Sixty (40%) patients also had aortic arch repairs and 53 (35%) coronary artery bypasses. RESULTS: The early 30-day survival and stroke rates were 99% (150 of 151) and 0% (0 of 151), respectively: CVG 100% (67 of 67), 0%; VPR 100% (13 of 13), 0%; SVR 98% (49 of 50), 0%; RA 100% (21 of 21), 0% (p = not significant [NS]). On late follow-up of all patients (5 to 92 months; 96% complete 1998), 3 CVG, 2 VPR, 6 SVR, and 0 RA patients died with respective 5-year Kaplan-Meier survival rates of 88.4%, 70%, 69%, and 100% (p = 0.07, log-rank test). The respective linear rates for stroke were 0%, 5.5% (n = 1), 0%, and 0%; for hemorrhage were 0%, 0%, 0%, and 0%; and for endocarditis were 2.2% (n = 3), 0%, 0%, and 0% (p = NS). There were 11 late deaths and no patient required reoperation or ruptured the ascending aorta or the aortic arch. CONCLUSIONS: With careful selection of the appropriate method excellent early and late results can be achieved.

Adult↗
PubMed1999

Intimal tear without hematoma: an important variant of aortic dissection that can elude current imaging techniques.

BACKGROUND: The modern imaging techniques of transesophageal echocardiography, CT, and MRI are reported to have up to 100% sensitivity in detecting the classic class of aortic dissection; however, anecdotal reports of patient deaths from a missed diagnosis of subtle classes of variants are increasingly being noted. METHODS AND RESULTS: In a series of 181 consecutive patients who had ascending or aortic arch repairs, 9 patients (5%) had subtle aortic dissection not diagnosed preoperatively. All preoperative studies in patients with missed aortic dissection were reviewed in detail. All 9 patients (2 with Marfan syndrome, 1 with Takayasu's disease) with undiagnosed aortic dissection had undergone >/=3 imaging techniques, with the finding of ascending aortic dilatation (4.7 to 9 cm) in all 9 and significant aortic valve regurgitation in 7. In 6 patients, an eccentric ascending aortic bulge was present but not diagnostic of aortic dissection on aortography. At operation, aortic dissection tears were limited in extent and involved the intima without extensive undermining of the intima or an intimal "flap." Eight had composite valve grafts inserted, and all survived. Of the larger series of 181 patients, 98% (179 of 181) were 30-day survivors. CONCLUSIONS: In patients with suspected aortic dissection not proven by modern noninvasive imaging techniques, further study should be performed, including multiple views of the ascending aorta by aortography. If patients have an ascending aneurysm, particularly if eccentric on aortography and associated with aortic valve regurgitation, an urgent surgical repair should be considered, with excellent results expected.

Adult↗
PubMed1999

Chronic traumatic aortic pseudoaneurysm: resolution with observation.

Immediate operative repair is the most commonly recommended treatment for traumatic aortic ruptures, regardless of age or size of the lesion. We report a patient who presented with a large chronic aortic pseudoaneurysm and has been thus far managed nonoperatively with shrinkage of his lesion and no symptoms.

Adult↗
PubMed1999

How to obtain hemostasis after aortic surgery.

BACKGROUND: The establishment of hemostasis without the excessive transfusion of homologous blood and blood products is critical to successful aortic surgery. METHODS AND RESULTS: By using preoperative autologous blood donation and intraoperative blood conservation measures, 85% of patients can undergo aortic surgical procedures without homologous blood or product transfusions, and almost three-quarters of patients will still not have required homologous transfusions by the time of discharge. In contrast, three-quarters of those patients who cannot donate blood preoperatively will require homologous blood transfusions. CONCLUSIONS: The strategy described is safe: our overall survival rate for 204 patients has been 98%, with a 1% incidence of stroke.

Aortic Aneurysm↗
PubMed1999

An approach to spinal cord protection during descending or thoracoabdominal aortic repairs.

BACKGROUND: During the past few years, after much research, progress has been made in reducing the risk of spinal cord injury after descending or thoracoabdominal aortic repairs. METHODS: Based on that research I describe a method to reduce the risk of spinal cord injury. RESULTS: Our data show that with this technique, less than 5% of our patients had a permanent injury whereby they are unable to walk. CONCLUSION: The use of intrathecal papaverine, cerebrospinal fluid drainage, hypothermia, and reimplantation of intercostal arteries from below T6 to and including L1 are recommended.

Aortic Aneurysm, Abdominal↗
PubMed1999

Readmission after cardiac operations: prevalence, patterns, and predisposing factors.

OBJECTIVES: This study was undertaken (1) to determine the prevalence of hospital readmission within 1 month of discharge after cardiac operations, (2) to categorize diagnoses responsible for readmission, and (3) to examine predischarge patient factors that influenced readmission. METHODS: Data at 1 month after discharge were obtained for 1665 (98.4%) of 1692 patients who underwent cardiac operations between January 1996 and July 1998. RESULTS: Two hundred twenty-five patients (13.5%) were readmitted to a hospital within a 1-month period after discharge. Forty-eight percent of readmissions were to other hospitals. The most common readmission problems were congestive heart failure (15.6%), atrial fibrillation (12.9%), chest pain (12.0%), wound problems (10.2%), and gastrointestinal problems (8.0%). Hospital discharge on or before the fifth postoperative day was associated with a lower prevalence of subsequent readmission. The independent predictors of a readmission for congestive heart failure were postoperative stay longer than 5 days, diabetes, New York Heart Association functional class IV, preoperative congestive heart failure, total blood product use, the need for postoperative inotropes, body mass index greater than 28 kg/m(2), and reoperation for bleeding. CONCLUSIONS: The prevalence of rehospitalization during the first month after discharge is not trivial. Other than postoperative atrial fibrillation, readmission is probably the single most likely adverse event to befall a patient in the early postoperative period. Patients who are discharged early do not appear to be at increased risk. Patterns in readmission diagnoses suggest opportunities for preventive strategies.

Aged↗
PubMed1999

Coronary-subclavian steal associated with severe aortic stenosis treated with combined percutaneous stenting and minimally invasive aortic valve replacement.

We describe coronary-subclavian steal restricting flow to the left internal mammary artery (LIMA) associated with critical aortic stenosis treated with combined percutaneous transluminal stenting and minimally invasive aortic valve replacement (AVR). An 86-year-old patient had coronary artery bypass graft placement (CABG) seven years prior with the LIMA anastomosed to the left anterior descending coronary artery (LAD). At the time of CABG, the patient had mild aortic stenosis and normal left ventricular function. By the time of re-presentation with refractory angina and heart failure, the patient had developed critical aortic stenosis. Because repeat CABG with median sternotomy risked damaging the LIMA, pre-operative revascularization was planned to minimize the likelihood of peri-operative ischemia. Stenting of the subclavian artery was performed prior to minimally invasive AVR.

Aged↗
PubMed1998

Expanding surgical options using minimally invasive techniques for cardio-aortic and aortic procedures.

In an effort to minimize the morbidity and mortality of open cardio-aortic and aortic operations, which are ranked among the most extensive procedures, surgeons are attempting to use smaller minimal-access incisions, less-invasive open procedures, or more distal access sites to place aortic stented grafts by intraluminal closed methods. We review the latest trends in this rapidly evolving new field of minimally invasive surgery.

Aortic Diseases↗
PubMed1998

Reduction of neurologic injury after high-risk thoracoabdominal aortic operation.

BACKGROUND: Of all aortic operations, thoracoabdominal aortic repairs have the highest risk of spinal cord neurologic injury, manifest by lower limb paraplegia or paraparesis. Cerebrospinal fluid drainage combined with intrathecal papaverine (CSFDr + IP) may reduce the risk and severity of neurologic injury. The objective of this study was to evaluate the effect of CSFDr + IP to prevent neurologic injury after high-risk thoracoabdominal aneurysm repairs. METHODS: We screened 64 patients before operation with descending thoracic or thoracoabdominal aneurysms for possible inclusion in a prospective, randomized study. Thirty-three patients with high-risk type I and II thoracoabdominal aneurysms met inclusion criteria and 17 were randomly assigned to CSFDr + IP and 16 to the control group. The study was terminated early after interim analysis revealed a significant difference. RESULTS: Of 64 patients screened, 2 patients died after operation (3.1%, 2/64); both were in the randomized study (6%, 2/33), and neither had a neurologic injury. Neurologic injury developed in 2 CSFDr + IP patients and 7 control patients (p = 0.0392). Control patients also had lower postoperative motor strength scores (p = 0.0340). On multivariate analysis, risk factors for neurologic injury included (p < 0.05) longer cross-clamp time, failure to actively cool with bypass, and postoperative hypotension, whereas CSFDr + IP was protective. Logistic regression showed that CSFDr + IP and active cooling significantly reduced the risk of injury and that the two combined modalities were additive. Of 64 patients screened, only 2 (3%) had a permanent neurologic deficit preventing ambulation. CONCLUSIONS: For high-risk thoracoabdominal aneurysms, CSFDr + IP was effective in reducing the incidence and severity of neurologic injury. Active cooling may be further additive to CSFDr + IP protection, although this needs to be confirmed in a larger study.

Adult↗
PubMed1998

Minimal-access aortic and valvular operations, including the "J/j" incision.

BACKGROUND: We compared five current minimal-access approaches, namely, parasternal incision, transverse sternotomy, manubrial inverted "T" incision, incomplete mediastinotomy, and our "J/j" incision, to operations in matched patients, including aortic operations. METHODS: In a case-control study of 74 patients, 37 individuals consecutively underwent minimal-access operations (aortic valve, 18, including one mitral valve operation; composite valve graft, six, including one arch and one transaortic mitral valve operation for a patient with Marfan's syndrome; ascending aorta operation, two; root repair/reconstruction, three; mitral valve repair/replacement, seven, including one maze operation; and atrioseptal defect repair, one). The patients were matched by sex, age, surgeon, and operation with 37 control patients who had standard incisions. Patients having the "J/j" incision (n=25) had sternotomies from the first right intercostal space, or sternal notch, to the third to fifth right intercostal space. RESULTS: Minimal-access patients had a shorter postoperative hospital stay than standard incision patients (6.2 versus 8.2 days; p=0.0055), and required similar volumes of blood (0.86 versus 1.03 units; p=0.7243), postoperative morphine dosages (28 mg versus 40 mg, p=0.0643), and oral narcotics (8.1 versus 10.0 doses; p=0.3562). "J/j" incision patients, however, required less morphine (20.6 mg versus 40.9 mg; p=0.0028), but not fewer doses of oral narcotics (7.5 versus 9.9 doses; p=0.2640) and had the shortest postoperative stay (5.1 versus 8.1 days; p < 0.0001). No stroke or clinically noted neurocognitive deficit developed. One minimal-access patient (1/37, 2.7%) with severe preoperative pulmonary morbidity died of adult respiratory distress syndrome. Sternal nonunion developed in 1 patient with an inverted "T" manubrial incision. In a further seven patients, the "J/j" incision was used without a problem, for a total of 32 patients. This compared with a consecutive series of 125 aortic valve replacement operations without a death and 181 patients undergoing ascending arch operations with two 30-day hospital deaths (1.1%) and two strokes (1.1%). CONCLUSIONS: Minimal-access incisions are associated with shorter hospital stays. For the "J/j" incision, even if used for more extensive double-valve, ascending aortic arch, or composite valve operations, postoperative pain appears to be less and patients are discharged even earlier.

Adult↗
PubMed1998

"J" incision minimal-access valve operations.

BACKGROUND: Having used various minimal access incisions in 45 patients and our approach of "J" incisions, we wished to evaluate results with the latter incision. METHODS: Between January 1997 and September 1997, 33 consecutive unselected patients underwent minimal access aortic valve operations (n = 25, including 4 composite grafts [1 hemiarch, 1 transaortic MVR], 2 root and valve repairs, and 1 double valve replacement), mitral valve operations (n = 6, 4 repairs, 2 replacements, including 1 maze procedure), or atrial septal defect repairs through "J" incisions (n = 2). RESULTS: One patient with preoperative severe pulmonary disease died of adult respiratory distress syndrome (3%, 1/33). The mean cross-clamp and bypass times were 85.9 minutes and 113.5 minutes, although for recent isolated aortic valve replacement operations the mean was 44 minutes (range, 39 to 51 minutes). Mean operative blood use was 0.33 units, and no patient required reoperation for bleeding. The mean time before extubation, intensive care unit stay, and postoperative stay were 0.44 days, 0.58 days, and 4.8 days. No strokes occurred. Mean postoperative pain medication requirements were 22.9 mg of morphine and 7.1 oral narcotic doses. CONCLUSIONS: "J" incisions are safe alternatives to other incisions, result in good exposure, do not require division of the mammary arteries, minimize postoperative pain medication requirements, and, with experience, can be performed with acceptable aortic cross-clamp times.

Adult↗
PubMed1998

Management of segmental intercostal and lumbar arteries during descending and thoracoabdominal aneurysm repairs.

The etiology of spinal cord injury after descending or thoracoabdominal operation is multifactorial. There are three major events that may cause the injury. This review addresses the second, namely the operative management of the segmental intercostal and lumbar arteries. However, failure to address any of the etiological events may result in injury, and thus a multimodal approach is required to prevent spinal cord injury.

Animals↗