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Valvular Surgery (valvular + surgery)

Distribution by Scientific Domains
Medical Sciences100%

Selected Abstracts

Beating-Heart Valvular Surgery: A Possible Alternative for Patients with Severely Compromised Ventricular Function

JOURNAL OF CARDIAC SURGERY, Issue 2 2002
Richard J. Kaplon M.D.
We report a novel approach to myocardial protection in a patient requiring multi-valve surgery who had an ejection fraction of 15%. Warm oxygenated blood was infused continuously both antegrade and retrograde during aortic valve replacement and mitral and tricuspid valve repair. Adequacy of perfusion was confirmed by the absence of electrocardiographic changes. Clinical improvement suggests that this strategy of myocardial protection warrants further investigation. [source]

Atrial Size Reduction as a Predictor of the Success of Radiofrequency Maze Procedure for Chronic Atrial Fibrillation in Patients Undergoing Concomitant Valvular Surgery

JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 8 2001
MIEN-CHENG CHEN M.D.
Radiofrequency Maze Procedure and Atrial Size.Introduction: Previous studies showed that the surgical maze procedure can restore sinus rhythm and atrial transport function in patients with chronic atrial fibrillation (AF). However, no previous studies discussed the association of atrial size reduction and the success of sinus conversion by the radiofrequency (RF) maze procedure for chronic AF. Methods and Results: A total of 119 chronic AF patients undergoing valvular operations were included in this study. Sixty-one patients received RF and cryoablation to create lesions in both atria to simulate the surgical maze II or III procedure (RF maze II or RF maze III; 13 patients, group 1) or a modified maze pattern (RF maze "IV"; 48 patients, group 2). The other 58 patients who underwent valvular operations alone without the maze procedure served as control (group 3). At 3-month follow-up after operation, sinus rhythm was restored in 73%, 81%, and 11% of patients in groups 1, 2 and 3, respectively. Preoperative left and right atrial sizes were not statistically significant predictors of sinus conversion by the RF maze procedure. However, as a result of postoperative reduction of atrial sizes, postoperative left atrial diameter was significantly smaller in patients who had sinus conversion by the RF maze procedure than in patients who did not regain sinus rhythm (45.0 ± 7.0 mm vs 51.0 ± 8.0 mm; P = 0.03). Postoperative right atrial area of patients who had sinus conversion by the RF maze procedure also was significantly smaller than that of patients who did not regain sinus rhythm (18.1 ± 4.4 cm2 vs 28.5 ± 8.2 cm2; P = 0.008). Conclusion: Atrial size reduction appears to predict the success of sinus conversion with the RF maze procedure used in conjunction with valvular surgery. [source]

Bridging Patients to Cardiac Transplantation

CONGESTIVE HEART FAILURE, Issue 5 2000
Michael B. Higginbotham MD
Potential recipients of heart transplants have the most advanced form of congestive heart failure, in which standard therapy fails to maintain clinical stability. In the absence of guidelines derived from evidence obtained in clinical trials, caring for these patients becomes a challenge. A successful approach requires the proper coordination of surgical and nonsurgical strategies, including revascularization and valvular surgery as well as mechanical ventricular support and medical strategies. Intensive medical therapy is the most commonly used approach for prolonged bridging to transplantation. Although carefully individualized regimens are necessary to achieve desired goals, most centers adopt a fairly standardized approach involving vasodilators, diuretics, and inotropic support. Bridging patients with cardiac decompensation to transplantation presents a major therapeutic challenge. Appropriate strategies will maximize patients' chances that the bridge from decompensation to transplantation remains intact. [source]

Avecor Trillium Oxygenator Versus Noncoated Monolyth Oxygenator: A Prospective Randomized Controlled Study

JOURNAL OF CARDIAC SURGERY, Issue 4 2008
Frédéric Vanden Eynden M.D.
This study was designed to study the effects of the surface coating of a hollow fiber membrane oxygenator on coagulation, inflammation markers, and clinical outcomes. The biomaterials used to coat the membrane include heparin, polyethylene oxide chains (PEO), and sulfate/sulfonate groups. The coated membrane was compared to an uncoated oxygenator made of polypropylene. Methods: Two hundred patients who were scheduled to undergo valve repair and/or replacement surgery with or without coronary surgery were enrolled in the study. The patients were randomized to undergo CPB with either the Avecor oxygenator with TrilliumÔ (Medtronic, Minneapolis, MN, USA), a biopassive surface, or the Monolyth (Sorin, Irvine, CA, USA) oxygenator without coating. The primary and secondary endpoints were the differences between these oxygenators in regard to patients' biochemistry, coagulation profiles, inflammatory mediators, and clinical outcomes, including blood loss and neurological events. Results: There were no differences between the two groups in terms of biochemistry, coagulation profile, inflammatory mediator release, and blood loss. Five patients in the Avecor group showed clinical evidence of a stroke confirmed with computerized tomography (CT) scan imaging, and none in the noncoated oxygenator group. Conclusion: The oxygenator Avecor offers similar results in terms of inflammation and coagulation profiles and blood loss during valvular surgery compared to a standard uncoated control oxygenator. The rate of neurological events was unusually elevated in the former group of patients, with only speculative explanation at this point. Further studies are warranted to clarify this aspect. [source]

Atrial Size Reduction as a Predictor of the Success of Radiofrequency Maze Procedure for Chronic Atrial Fibrillation in Patients Undergoing Concomitant Valvular Surgery

JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 8 2001
MIEN-CHENG CHEN M.D.
Radiofrequency Maze Procedure and Atrial Size.Introduction: Previous studies showed that the surgical maze procedure can restore sinus rhythm and atrial transport function in patients with chronic atrial fibrillation (AF). However, no previous studies discussed the association of atrial size reduction and the success of sinus conversion by the radiofrequency (RF) maze procedure for chronic AF. Methods and Results: A total of 119 chronic AF patients undergoing valvular operations were included in this study. Sixty-one patients received RF and cryoablation to create lesions in both atria to simulate the surgical maze II or III procedure (RF maze II or RF maze III; 13 patients, group 1) or a modified maze pattern (RF maze "IV"; 48 patients, group 2). The other 58 patients who underwent valvular operations alone without the maze procedure served as control (group 3). At 3-month follow-up after operation, sinus rhythm was restored in 73%, 81%, and 11% of patients in groups 1, 2 and 3, respectively. Preoperative left and right atrial sizes were not statistically significant predictors of sinus conversion by the RF maze procedure. However, as a result of postoperative reduction of atrial sizes, postoperative left atrial diameter was significantly smaller in patients who had sinus conversion by the RF maze procedure than in patients who did not regain sinus rhythm (45.0 ± 7.0 mm vs 51.0 ± 8.0 mm; P = 0.03). Postoperative right atrial area of patients who had sinus conversion by the RF maze procedure also was significantly smaller than that of patients who did not regain sinus rhythm (18.1 ± 4.4 cm2 vs 28.5 ± 8.2 cm2; P = 0.008). Conclusion: Atrial size reduction appears to predict the success of sinus conversion with the RF maze procedure used in conjunction with valvular surgery. [source]

The incidence and consequences of mental disturbances in elderly patients post cardiac surgery,a comparison with younger patients

CLINICAL CARDIOLOGY, Issue 7 2000
J. A. Heijmeriks M.D.
Abstract Background: Limited data exist about the incidence and consequences of mental confusion following open heart surgery in different age groups. Likewise, little is known about preoperative predictors of mental confusion. Methods: Two-hundred consecutive patients, aged ,,75 years (Group 1), and 400 procedure- and gender-matched younger patients (Group 2) who underwent coronary or valvular surgery were included in a prospective study. The relation between postoperative mental confusion, mortality, morbidity, and quality of life was studied. Results: Mental confusion was present in 11.8% Group 2 and 22.6% Group 1 patients. The incidence was higher after valvular surgery. Preoperative risk factors in Group 1 patients were diabetes mellitus, a history of heart failure, weak carotid pulsations, and repeat surgery. Late mortality, after a median follow-up duration of 31 months, was significantly worse in patients who were confused, which was related to the underlying disease. Recovery of quality of life was clearly diminished in elderly patients with confusion in contrast to younger patients. Conclusion: Postoperative mental confusion has a high incidence in the elderly population and is associated with a diminished quality of life. [source]