Biomedical subjects

Marc R Moon

Publications and source records attributed to Marc R Moon.

40 records · Page 3Linked to original sources

PubMedDate not supplied

Does functional mitral regurgitation improve with isolated aortic valve replacement?

BACKGROUND: The surgical treatment of mitral valve regurgitation (MR) at the time of aortic valve replacement (AVR) remains controversial. The purpose of this study was to evaluate the change in severity of MR following isolated AVR, and to determine survival benefit. METHODS: Between 1991 and 2001, 250 patients underwent isolated AVR; 196 patients had concomitant functional MR. Follow-up transthoracic echocardiography (TTE) was available on 107 patients, with a median of 818 +/- 752 days. Aortic valve was stenotic in 77 and regurgitant in 30 patients. RESULTS: Mean age was 67 +/- 15 years and 57 (53%) were male. Preoperative MR was trivial (1+) in 27 (25%), mild (2+) in 44 (41%), moderate (3+) in 29 (27%), and severe (4+) in 7 (7%). At follow-up TTE, MR improved by 1 or 2 grades in 48 patients (45%). Of patients with preoperative 2+ MR, 19 (43%) improved, 16 (36%) remained unchanged, and 9 (21%) worsened. Although some patients with preoperative 3+ MR exhibited improvement, 11 (38%) remained with moderate-to-severe MR. Of those with a preoperative MR of 4+, 3 (71%) improved, and 4 remained with 3-4+ MR. For patients with preoperative 1 to 2+ MR, survival at 3 years was 98% compared to 78% for those with 3 to 4+ MR (p = 0.038). CONCLUSION: Functional MR does not always improve after isolated AVR. Survival is lower for patients with preoperative 3 to 4+ MR. Moderate-to-severe MR should be repaired at the time of aortic valve surgery.

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PubMedDate not supplied

Contemporary results of total aortic arch replacement.

BACKGROUND AND AIM: Aneurysmal dilatation of the aortic arch is uncommon, and the complex anatomy involved imposes unique technical challenges. The results of surgical intervention reported from large centers are improving; however, the degree to which these results are reproducible by other surgeons is less clear. We therefore reviewed our recent experience with total aortic arch replacement. METHODS: Between July 1, 1997 and July 1, 2001 19 patients underwent complete aortic arch replacement, with or without concomitant procedures. We retrospectively reviewed perioperative results retrieved from the computerized database and clinical records. RESULTS: The mean age of the study population was 68 +/- 8.3 years (range 52 to 82), with women predominating (11 women, 8 men). All patients had hypertension. Patient history indicated active or past tobacco abuse in 16 patients (80%); cerebrovascular disease in 3, and peripheral vascular disease in 7 patients. Associated procedures included an elephant trunk in 12 (63%), replacement of the upper descending thoracic aorta in 5 (26%), concomitant coronary artery bypass in 5 (26%), and aortic root replacement in 3 (16%). One patient underwent replacement of the entire aorta from sinotubular ridge to iliac bifurcation in a single procedure. Brachiocephalic reconstruction with a "Y-graft" permitting early antegrade cerebral perfusion was performed in 12 patients. Retrograde cerebral perfusion was performed in ten patients (53%). Perioperatively, death occurred in two patients (11%) and stroke in two (11%). CONCLUSIONS: With cautious application, techniques developed in high-volume centers can also achieve satisfactory results when used at centers with a more modest case volume.

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PubMedDate not supplied

Morbidity and mortality of cardiac surgery following renal transplantation.

BACKGROUND: With improved survival following renal transplantation, the number of patients undergoing cardiac surgery has increased. The purpose of this study was to review the morbidity, mortality, and allograft function in renal transplant patients undergoing major cardiac surgery. METHODS: Retrospective database review of consecutive renal transplant patients undergoing cardiac surgery from 1987 to 2002. Patients requiring dialysis (D) before cardiac surgery versus those with stable renal transplants (ND) were compared. RESULTS: Cardiac surgery was performed in 46 patients during the study period. Twenty patients (42%) required dialysis (D) before surgery while 26 (58%) had stable allograft function (ND). Among patients who had stable allograft function prior to surgery, there was no allograft loss. In the ND group, preoperative and discharge creatinine levels were 2.17 +/- 1.0 and 2.4 +/- 1.5 mg/dL, respectively. All operative deaths occurred in the dialysis dependent group. The 30-day and 3-year survival, respectively was 80% and 20% in the D group compared to 100% and 69% amongst the ND group (p </= 0.01). Infectious complications consisted of pneumonia and sepsis each in 8.5% and of deep sternal wound infection in 4.3% of the entire group. CONCLUSIONS: (1) Morbidity and mortality of cardiac surgery in renal transplant patients with stable allograft function is low and stable allograft function can be maintained without allograft loss. (2) Mortality following cardiac surgery is significantly higher among renal transplant patients who become dialysis dependent and intermediate-term survival is poor.

Cardiac Surgical Procedures↗

PubMedDate not supplied

Endovascular repair of traumatic descending thoracic aortic disruptions: should endovascular therapy become the gold standard?

Acute arterial disruptions of the thoracic aorta are rare and often lethal. They are most often due to blunt trauma and occur most commonly just distal to the left subclavian artery origin in the setting of multisystem injuries. The very proximal nature of the lesion in survivors makes open surgical repair hazardous, with mortality rates reaching over 20%. Endovascular therapy is a new and attractive option for the treatment of those challenging patients. Since March 2002, 3 patients with blunt and 1 patient with a stable iatrogenic descending aortic injury were successfully treated at this institution. Spiral computed tomography followed by angiography was used for diagnosis. No preexisting aortic pathology was present. Major associated injuries included unstable thoracic spinal fractures, abdominal solid organ injuries, and hip fractures, making the subjects poor surgical candidates. The Talent Endovascular Graft was deployed via open femoral or iliac artery access under fluoroscopic guidance. All 4 patients underwent successful exclusion of their thoracic pseudoaneurysm with use of the Talent endovascular graft. One patient required partial coverage of the left subclavian artery, and a second patient had an iliac artery stent deployed after traversal of an area of stenosis with the delivery system. There were no cardiac, neurologic, pulmonary, or peripheral vascular complications. Acute aortic disruption, with its associated high surgical morbidity and mortality, is an excellent indication for endovascular therapy to improve patient outcomes. More long-term data are needed on repair durability.

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