Approximately 50,000 valve replacement operations take place in Europe annually and almost as many valve repair procedures. Previous European guidelines on management of patients after valve surgery were last published in 1995 and were limited to recommendations about antithrombotic prophylaxis. American guidelines covering the broader topic of the investigation and treatment of patients with valve disease were published in 1998 but devoted relatively little space to post-surgical management. This document represents the consensus view of a committee drawn from three European Society of Cardiology (ESC) Working Groups (WG): the WG on Valvular Heart Disease, the WG on Thrombosis, and the WG on Rehabilitation and Exercise Physiology. In almost all areas of patient management after valve surgery, randomized trials and meta-analyses do not exist. Such randomized trials as do exist are very few in number, are narrowly focused with small numbers, have limited general applicability, and do not lend themselves to meta-analysis because of widely divergent methodologies and different patient characteristics. Recommendations are therefore almost entirely based on non-randomized studies and relevant basic science.

Anticoagulants↗

PubMed2005

Left atrial extension of a Wilms' tumor.

Isolated involvement of the left heart chambers by metastases of malignant tumors is extremely rare. We report a case of an 8-year-old child, with a left atrial metastasis of a Wilms' tumor detected in a control nuclear magnetic resonance 1 year after left inferior lobectomy for metastatic extension of the kidney tumor, which was diagnosed 4 years earlier. The metastasis was excised en bloc with a disc of the posterior left atrial wall.

Child↗

PubMed2005

Left ventricular aneurysms: early and long-term results of two types of repair.

OBJECTIVE: Controversy still exists regarding the optimal surgical technique for postinfarction left ventricular (LV) aneurysm repair. We analyze the efficacy of two established techniques, linear vs. patch remodeling, for repair of dyskinetic LV aneurysms. METHODS: Between May 1988 and December 2001, 110 consecutive patients underwent repair of LV aneurysms. These represent 2.0% of a total group of 5429 patients who underwent isolated CABG during the period. Seventy-six (69.1%) patients were submitted to linear repair and 34 (30.9%) to patch remodelling. There were 94 (84.5%) men and 17 women, with a mean age of 59.2+/-9.2 years. Coronary surgery was performed in all patients (mean no. of grafts/patient, 2.7+/-0.8) and 14 (12.7%) had associated coronary endarterectomy. Forty-four (40.0%) patients had angina CCS class III/IV (linear 43.4%, patch 32.4%, NS) and the majority was in NYHA class I/II (88.2% in both groups). Left ventricular dysfunction (EF>40%) was present in 72 (65.5%) patients (linear 61.8%, patch 73.5%, NS). RESULTS: There was no perioperative mortality, and major morbidity was not significantly different between linear repair and patch repair groups. During a mean follow-up of 7.3+/-3.4 years (range 4-182 months) 14 patients (14.3%) had died, 12 (85.7%) of possible cardiac-related cause. Actual global survival rate was 85.7%. Actuarial survival rates at 5, 10 and 15 years were 91.3, 81.4 and 74%, respectively. There was no significant difference in late survival between the patch and the linear groups. At late follow-up the mean angina and NYHA class were, 1.3 (preoperative 2.4, P<0.001) and 1.5 (preoperative 1.7, NS), respectively, with no difference between the groups. There was no significant difference in hospital readmissions for cardiac causes (linear 22.8% and patch 37.0%). CONCLUSIONS: The technique of repair of postinfarction dyskinetic LV aneurysms should be adapted in each patient to the cavity size and shape, and the dimension of the scar. Both techniques achieved good results with respect to perioperative mortality, late functional status and survival.

Adult↗

PubMed2005

The aortic valve: an everlasting mystery to surgeons.

Explore the source record for details and available documents.

Aortic Aneurysm↗

PubMed2005

How much can we do to reach the ideal valve prosthesis?

Explore the source record for details and available documents.

Heart Valve Prosthesis↗

PubMed2005

Donor mitral valve repair in cardiac transplantation.

Explore the source record for details and available documents.

Cardiac Surgical Procedures↗

PubMed2005

Left-ventricular aneurysms: from disease to repair.

Myocardial infarction may be complicated by the formation of a left-ventricular aneurysm that distorts the normal elliptical geometry of the ventricle to produce a dilated spherical ventricle with limited contractile and filling capacities. One of the consequences is congestive heart failure, which may be refractory to medical therapy and require surgical treatment. Surgical methods to restore the volume and shape of the left ventricle have evolved over the years. Nevertheless, although surgery for left-ventricular aneurysms has been performed for almost 50 years, the most appropriate approach is still controversial. This review gives an overview of the postinfarction left-ventricular aneurysm, tackling issues from the disease itself to surgical and other techniques of ventricular remodeling.

Cardiac Surgical Procedures↗

PubMed2005

[Acute aortic dissection].

Acute aortic dissection is a relatively common pathology, which is related to the high incidence of arterial hypertension observed in some population subgroups. It is accompanied by a high mortality rate if not treated immediately. Early diagnosis is relatively simple but depends on a high index of suspicion. Its etiopathogenesis is related to cystic medial necrosis. In the majority of cases, the aortic wall is abnormal along its entire length. Surgery is indicated in virtually all type A dissections, with involvement of the ascending aorta, and in many type B dissections, characterized by isolated involvement of the descending aorta. In the majority of the latter, however, medical therapy appears to lead to better results than surgery, but in recent times, treatment has been revolutionized by the use of stents. Surgery is rarely curative. Hence, long-term follow-up (probably for life) is essential. This includes strict control of arterial hypertension and monitoring of the untreated aortic segments, and especially any residual patent false lumen, which is observed in the majority of cases, in order to prevent rupture and to minimize the consequences of the formation of false aneurysms.

Acute Disease↗

PubMed2004

Nontransplant surgical options for congestive heart failure.

Although advanced heart failure has been considered the main indication for heart transplantation, the increasing number of candidates and shortage of organs for transplantation, with accumulating waiting lists, has originated another look into more conventional surgery, previously considered of prohibitive risk. In fact, many cases are a result of anatomic lesions that can be corrected by conventional surgery, and in the past decade many surgical groups have obtained good and even excellent results in the treatment of aortic stenosis with low output, and in aortic and mitral regurgitation with severe left ventricular (LV) dysfunction. Also, ischemic and idiopathic dilated cardiomyopathy have been successfully treated by several types of LV remodeling surgery, with or without coronary grafting. Many of these procedures achieved excellent operative, medium-, and long-term results and survival, which match well those observed with cardiac transplantation, most often with advantages in the quality of life and, not unimportantly, in financial costs. For operated patients, especially those with ischemic cardiomyopathy, close follow-up for cardiac failure is extremely important in order to detect the right moment for heart transplantation, if it becomes necessary.

Cardiomyopathy, Dilated↗

PubMed2004

Surgical resection of lung metastases from epithelial tumors.

BACKGROUND: One of the main characteristics of malignant tumors is the capability to disseminate, giving rise to local or distant metastases. Pulmonary metastases occur in almost 30% of all oncology patients, and secondary lung tumors are more frequent than primary ones. Surgical resection of metastases is now a well-established procedure, but the results vary with the histologic type of the primary tumor. We wished to identify factors affecting late survival after pulmonary metastasectomy for epithelial tumors. METHODS: We have reviewed retrospectively data for 78 patients who underwent 101 curative resections of epithelial pulmonary metastases between January 1988 and December 2000 at our department. Potential prognostic factors affecting late survival, namely histology of the primary tumor, disease-free interval, number and size of resected lung metastases, involvement of lymph nodes, use of nonsurgical adjuvant therapy, and relapse of pulmonary metastases, were investigated. RESULTS: There was no operative mortality, and the postoperative course was uneventful in 91.1% of the procedures. The mean disease-free interval was 48.2 +/- 59.8 months, and the mean follow-up after the first pulmonary metastasectomy was 40.8 +/- 31.5 months. Mean overall survival was 81.0 +/- 10.0 months, and 5-year and 10-year survival rates were 47.4% and 37.7%, respectively. By univariate and multivariate analyses, the disease-free interval and the prognostic grouping system proposed by the International Registry of Lung Metastases were found to significantly influence the long-term survival. Presence of symptoms also showed an important influence. CONCLUSIONS: Resection of epithelial pulmonary metastases is safe and effective, and is associated with very low perioperative morbidity and mortality and a reasonable 5-year and 10-year survival. In the present study, the disease-free interval influenced significantly the long-term survival. Our results did not differ significantly from (and in many cases compared favorably with) those described in the literature.

Adult↗

PubMed2004

Renal dysfunction after myocardial revascularization.

OBJECTIVES: In this study, we evaluate the incidence of and analyse the pre and intraoperative risk factors for the development of postoperative renal dysfunction (PRD), and the impact of such an event on perioperative mortality and on hospital length of stay. In addition, we sought to investigate the influence of a mildly increased serum creatinine (1.3-2.0 mg/dl) on perioperative mortality and morbidity. METHODS: The study included 2445 consecutive patients who had no pre-existing renal disease (creatinine or=2.1 mg/dl with a preoperative-to-postoperative increase >or=0.9 mg/dl. Univariate and multivariate analyses were performed where appropriate. RESULTS: Global 30-day mortality was 0.7%. The incidence of PRD was 5.6% (136 patients). Mortality for patients who experienced PRD was 8.8 vs. 0.1% for patients who did not (P<0.001). PRD increased the length of hospital stay by 3.4 days (7.6 vs. 11.0 days; P<0.001), and patients who needed haemodialysis (11%) had a perioperative mortality of 33.3% and a mean hospital length of stay of 16 days. Multivariable logistic regression identified the following variables as independent predictors of PRD: age (P=0.017; odds ratio (OR) 1.3 per 10 years), angina class III/IV (P=0.003; OR 1.7); cardiopulmonary bypass time (P=0.007; OR 1.01 per minute); preoperative serum creatinine levels: group 1 (1.3-1.6 mg/dl (P<0.001; OR 5.5)) and group 2 (1.7-2.0 mg/dl (P<0.001; OR 14.2)). Finally, a mild elevation of the preoperative creatinine level (1.3-2.0 mg/dl) increased significantly the probability of perioperative mortality, low cardiac output, haemodialysis and prolonged hospital stay. CONCLUSIONS: Although the likelihood of PRD in patients without pre-existing renal dysfunction is relatively low, it dramatically increases mortality, morbidity and length of stay after CABG. Mildly elevated (>1.2 mg/dl) preoperative serum creatinine level significantly increases the perioperative mortality and morbidity.

Aged↗

PubMed2004

The role of surgery (non-transplant) in the treatment of severe congestive heart failure.

Advanced heart failure has been considered the main indication for heart transplantation, but the increasing numbers of candidates and shortage of organs for transplantation, with growing waiting lists, has prompted another look at more conventional surgery, previously considered of prohibitive risk. In fact, many cases are the result of anatomical lesions which can be corrected by conventional surgery, and in the past decade many surgical groups have obtained good and even excellent results in the treatment of aortic stenosis with low output and in aortic and mitral regurgitation with severe LV dysfunction. Also, ischemic and idiopathic dilated cardiomyopathy have been successfully treated by several types of LV remodeling surgery, with or without coronary grafting. Many of these procedures have achieved excellent operative and medium- and long-term results and survival which compare favorably with those observed with cardiac transplantation, often with advantages in quality of life and, not unimportantly, in financial costs. For operated patients, especially those with ischemic cardiomyopathy, close follow-up for cardiac failure is extremely important in order to determine the right moment for heart transplantation, if it becomes necessary.

Cardiac Surgical Procedures↗