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Biomedical subjects

P P Urbanski

Publications and source records attributed to P P Urbanski.

9 recordsLinked to original sources
PubMed2006

Surgical repair of the aortic coarctation combined with complete replacement of the ascending aorta and aortic arch.

We present a 63-year-old patient with aortic valve stenosis, ascending aorta aneurysm, aortic coarctation as well as atherosclerotic, elongated, and stenosed aortic arch. Surgical treatment consisted of a complete ascending aorta replacement with a valved composite graft and complete replacement of the aortic arch including the isthmus, and was performed simultaneously through median sternotomy.

Aorta↗
PubMed2005

Modified technique of chordal replacement for mitral valve repair.

The appropriate length of the artificial chordae is crucial for the proper functioning of the mitral valve after chordal replacement. In the technique described here, the artificial chordae are assembled during surgery and their lengths fixed according to the individual anatomy; they are then first attached to the margin of the prolapsed leaflet and subsequently to the papillary muscle. This ensures that the ultimate length of the artificial chordae is determined during fixation at the papillary muscle and not during knotting at leaflet level.

Chordae Tendineae↗
PubMed2001

Aortic root replacement versus aortic valve replacement: a case-match study.

BACKGROUND: There is increasing evidence that patients with aortic valve disease and dilatation of the ascending aorta are at risk for later dissection or rupture of the aortic wall when the dilated ascending aorta is not replaced or reinforced at the time of aortic valve replacement. In order to find out whether the more complex surgical procedure of aortic root replacement carries a higher early or late postoperative risk than isolated aortic valve replacement, we conducted a matched-pair study with patients of both groups. METHODS: Between June 1993 and August 1998, 100 consecutive patients with aortic valve disease and ectasia/aneurysm of the ascending aorta underwent replacement of the aortic valve and the ascending aorta with a CarboSeal composite graft (CarboSeal; Sulzer Carbo-Medics Inc, Austin, TX). Identical bileaflet valve prostheses (CarboMedics; Sulzer CarboMedics Inc, Austin, TX) were implanted during the same time period in 928 patients for aortic valve disease. On the basis of various preoperative clinical variables 100 patients with aortic valve replacement were matched to the 100 patients with replacement of the aortic root. The duration of follow-up for both groups was similar with 37 + 17 months (range, 9 to 70) for the CarboSeal group and 38 + 14 months (range, 13 to 65) for the CarboMedics group. Survival and morbidity were calculated by Kaplan-Meier analysis and risk-adjusted mortality was evaluated by multivariate analysis in a Cox regression model. RESULTS: The early postoperative mortality of 1% in the CarboSeal group and 4% in the CarboMedics group was insignificantly different. Although the overall survival rate at 5 years was lower (60.7% vs 86.3%; p = 0.13) in the CarboSeal group, the freedom from cardiac mortality and valve-related morbidity was similar in the two groups. CONCLUSIONS: Replacement of the ascending aorta and aortic valve can be performed with similar operative risk, valve-related morbidity, and late cardiac mortality as isolated aortic valve replacement.

Adult↗
PubMed2000

Replacement of the aortic valve and ascending aorta with a valved stentless composite graft: technical considerations and early clinical results.

BACKGROUND: Replacement of the aortic valve and the ascending aorta with a conduit consisting of a mechanical valve and a Dacron tube has become a fairly common procedure. Commercially available conduits employing xenografts are rarely used for the same purpose, because if a reoperation becomes necessary due to degeneration of the valve prosthesis, usually the entire conduit must be replaced. A composite graft with a stentless valve, such as we describe in this article, avoids this problem, because in case of reoperation only the valve cusps need to be resected and the tube graft may be left in place. METHODS: Surgical technique of replacement of the aortic valve and the ascending aorta with a stentless composite graft and early results of the procedure are presented. RESULTS: Hemodynamics of the graft soon after surgery were excellent, with an average systolic gradient of 8 mm Hg and no regurgitation across the valve. There were two reoperations for bleeding in the early postoperative period. CONCLUSIONS: The stentless composite graft we describe provides excellent hemodynamics, has no need for anticoagulation, and is expected to offer a benefit in case of reoperation.

Adult↗
PubMedDate not supplied

Stentless valved composite graft for replacement of the aortic valve and ascending aorta.

BACKGROUND: Conduits with biological valves are rarely used for aortic root replacement because of technical problems when degeneration of the valve prosthesis requires reoperation. A composite graft as described could likely avoid this problem. MATERIAL AND METHODS: Between November 1998 and November 1999, 28 consecutive patients underwent replacement of the ascending aorta and aortic valve with a stentless valved composite graft. The indication for surgery was aneurysm of the ascending aorta (26 patients) and aortic dissection (2 patients). The composite graft was assembled during surgery using a stentless porcine aortic bioprosthesis (Toronto SPV) and a woven polyester collagen-coated vascular prosthesis (InterGard). RESULTS: There was no hospital mortality. Echocardiographic evaluation before discharge showed excellent hemodynamics with a mean transvalvular gradient of 8.5 mmHg (standard deviation I3.0 mmHg) and no regurgitation across the valve. Within a follow-up period of up to one year there was one late death because of a cerebral hemorrhage under anticoagulation. CONCLUSIONS: The valved composite graft described offers the excellent hemodynamic performance of a stentless biological valve and is expected to avoid major technical difficulties should later replacement of the biological prosthesis due to structural failure become necessary, because only the valve cusps need to be resected, leaving the tube graft untouched.

Aged↗