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Benefits of off-pump surgery are still widely debated in the literature comparing with conventional coronary artery bypass grafting. The aim of our study was to compare the late outcomes of patients who underwent on-pump redo coronary artery bypass surgery with those who had off-pump redo coronary artery bypass surgery.
Material and methods. Two groups of patients were compared. Group 1 consisted of 34 patients who underwent off-pump redo coronary artery bypass surgery, and Group 2 included 160 patients who underwent on-pump redo coronary artery bypass surgery. Both groups of patients were operated on by the same team of surgeons at the same time period. Groups did not differ by age, gender, functional class, preoperative myocardial infarction rate, and left ventricular function. More patients with hypertension were in the off-pump group. Significantly more grafts were performed in the on-pump group. Survival, presence of angina, reoccurrence of postoperative myocardial infarction, necessity of percutaneous transluminal coronary angioplasty and reoperations were evaluated in late follow-up period. The duration of follow-up was 3.37±2.15 years in the off-pump group and 3.27±2.36 years in the on-pump group.
Results. Survival after 6 years in the off-pump and on-pump redo coronary artery bypass surgery groups was 85.3% and 83.6%, respectively (P=0.758). Five years after redo operation, 54.9% of patients who underwent off-pump coronary artery bypass surgery and 69.3% of patients who underwent on-pump coronary artery bypass surgery had no angina (P=0.174). There were no major cardiac events (percutaneous transluminal coronary angioplasty, death, myocardial infarction, and reoperations) after 6 years in 69.7% of patients in the off-pump group and 76.9% of patients in the on-pump group (P=0.343). Five years after redo surgery, 79.4% of patients in the off-pump group and 91.9% in the on-pump group were free of percutaneous transluminal coronary angioplasty (P<0.02).
Conclusions. There was no difference in survival despite the fact that patients in the on-pump group received more grafts than those in the off-pump group. Recurrence of angina and incidence of major cardiac events were almost equal in both the groups. Percutaneous transluminal coronary angioplasty was more frequently performed in the patients of off-pump group at late follow-up. Full article

The aim of the study was to evaluate the long-term survival in patients undergoing surgical treatment for chronic aortic aneurysms with aortic regurgitation.
Material and methods. We analyzed survival data of 188 patients during follow-up period of 1 month to 20 years postoperatively. The patients were divided into the following groups according to the clinical course: Group 1 – chronic dissecting aneurysm of ascending aorta with aortic regurgitation (42 patients, 22.3%); Group 2 – chronic nondissecting aneurysm of ascending aorta with aortic regurgitation (146 patients, 77.7%). Mean NYHA functional class of the patients was 3.5±0.06. In the Group 1, 64.3% of the patients were in NYHA functional class IV; 35.7% of the patients were in NYHA class III. In the Group 2, the majority of the patients (58.2%) were in class III; in class IV – 41.8%. The most common etiological factors in both groups were atherosclerosis, arterial hypertension, and Marfan’s syndrome.
Results. No differences in overall and long-term survival rates between the groups were found. However, the patients who were in class III before the operation showed significantly higher overall and long-term survival rates in comparison with the survival rate of the patients who were in NYHA class IV preoperatively (overall survival rate, 91.4±3.0% vs 62.9±6.9%; and long-term survival rate, 93.2±2.7% vs 72.9±5.6; respectively). There were 24 deaths (12.8%) during the late postoperative period. The main causes of death were progressive heart failure and infective prosthetic endocarditis (Group 2), chronic heart failure and dysfunction of the conduit (Group 1).
Conclusions. The analysis of patients’ long-term survival demonstrated the efficacy of surgical treatment of such a complex pathology as chronic aneurysm of the ascending aorta with aortic valve regurgitation. The survival rate in the late postoperative period was higher in NYHA class III patients. The main causes of death were chronic heart failure and infective prosthetic endocarditis. Full article

Objective. When the patient condition contraindicates major surgery for descending thoracic aneurysms, the surgeon should consider using an ascending aorta to abdominal aorta bypass graft, leaving the diseased segment undisturbed. Our experience with eight patients is presented.
Material and methods. Between 1988 and 2008, eight patients were treated for the following indications: reoperation for coarctation (two patients), complicated descending aortic aneurysms (five patients), and posttraumatic descending aorta dissection (one patient). The mean age of the patients was 44±8 years (range, 27–53 years). There were 6 (75%) males and 2 (25%) females. Emergency operations were performed in three patients (two with aortic recoarctation, one with posttraumatic aortic dissection). Two cases were reoperations (both after recoarctation). Descending aorta was ligated in seven cases. Distal anastomosis was connected with abdominal aorta in four cases and with iliac arteries in four patients.
Results. Three early deaths occurred. Two patients died after emergency operation after recoarctation and posttraumatic aortic dissection, and one patient died after descending aorta aneurysm correction because of bleeding.
Conclusions. In complex aortic coarctation, extra-anatomic bypass operation remains an effective procedure. The usage of these procedures in patients with descending aortic aneurysms remains complicated. Full article