Search Results (3)

Background: new minimally invasive sternotomy (mini-sternotomy) procedures have improved the treatment outcome and reduced the incidence of perioperative complications leading to improved patient satisfaction and a reduced cost of aortic valve replacement in comparison to the conventional median sternotomy (full sternotomy). The aim of this study is to compare and gain new insights into operative and early postoperative outcomes, long-term postoperative results, and 5-year survival rates after aortic valve replacement through a ministernotomy and full sternotomy. Methods: This is a retrospective study of patients who underwent an isolated replacement of the aortic valve via a full sternotomy or ministernotomy from 2011 to 2016. From 2011 to 2016, 426 cardiac interventions were performed, 70 of which (16.4%) were of the ministernotomy and 356 (83.6%) of the full sternotomy. Through propensity score matching, 70 patients who underwent the ministernotomy (ministernotomy group) were compared with 70 patients who underwent the full sternotomy (control group). Results: in the propensity matching cohort, no statistical difference in operative time was noted (p = 0.856). The ministernotomy had longer cross clamp (88.7 ± 20.7 vs. 80.3 ± 24.6 min, p = 0.007) and bypass (144.0 ± 29.9 vs. 132.9 ± 44.9 min, p = 0.049) times, less ventilation time (9.7 ± 1.7 vs. 11.7 ± 1.4 h, p < 0.001), shorter hospital stay (18.3 ± 1.9 vs. 21.9 ± 1.9 days, p = 0.012), less 24-h chest tube drainage (256.2 ± 28.6 vs. 407.3 ± 40.37 mL, p < 0.001), fewer corrections of coagulopathy (p < 0.001), fewer patients receiving catecholamine (5.71 vs. 30.0%, p < 0.001) and better cosmetic results (p < 0.001). Moreover, the number of patients without complaints at 1 year after the operation was significantly greater in the ministernotomy group (p = 0.002), and no significant differences in the 5-year survival between the groups were observed. In the overall cohort, the ministernotomy had longer cross clamp times (88.7 ± 20.7 vs. 79.9 ± 24.8 min, p < 0.001), longer operative times (263.5 ± 62.0 vs. 246.7 ± 74.2 min, p = 0.037) and bypass times (144.0 ± 29.9 vs. 132.7 ± 44.5 min, p = 0.026), lower incidence of 30-day mortality (1(1.4) vs. 13(3.7), p = 0.022), shorter hospital stays post-surgery p = 0.025, less 24-h chest tube drainage, p < 0.001, and fewer corrections of coagulopathy (p < 0.001). Conclusions: the ministernotomy has a number of advantages compared with the full sternotomy and thus could be a better approach for aortic valve replacement. Full article

Aim of the study. To investigate preoperative status and results of surgery of patients with confirmed diagnosis of aortic root infection.
Materials and methods. We have analyzed data of 21 patients who were operated on at the Heart Surgery Center, Vilnius University, since January 1, 1997, till December 31, 2006. All these patients underwent surgery because of aortic root infection. The patients were aged 25–72 years (mean age, 53±14 years). There were 17 (80.9%) male patients. Sixteen patients (76%) preoperatively were in NYHA class IV. The abscesses of aortic root were confirmed preoperatively by means of esophageal echocardiography in 18 patients (86%). Blood cultures positive for Staphylococcus aureus were found in four patients (19.9%). All the patients underwent replacement of the aortic valve by mechanic prosthesis; one of these patients was reoperated because of persistent sepsis, and replacement of the aortic root with homograft was performed. The duration of follow-up of the patients was 1 to 10 years.
Results. Inhospital mortality rate was 14.3%. The causes of death included sustained heart failure and sepsis. All these patients were in NYHA functional class IV preoperatively; one of these patients had culture positive for Staphylococcus aureus. Inhospital survival was 85.7%, one-year postoperative survival – 80.9%, and both five-year and ten-year survivals were 76.0%. The long-term survival was negatively influenced by recurrent infective endocarditis, heart failure, and age. Death occurred in 1 patient (11.1%) of the 9 patients who at the time of surgery were younger than 50 years and 4 patients (33.3%) of the 12 who were older than 50 years at the time of operation.
Conclusions. The infection of aortic root is not common pathology; however, it is a complicated disease. Esophageal echocardiography is an informative method while diagnosing aortic root abscesses. The inhospital mortality is increased by the heart failure persisting after the operation and sepsis. The long-term survival is decreased by preoperative infective endocarditis of the prosthesis and heart failure. The mortality rate of patients older than 50 years is 3-fold higher than mortality rate of younger ones. 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