The authors report their experience with forty patients undergoing resection of middle and lower thirds carcinomas of the esophagus or proximal stomach, with esophagogastric or esophagojejunal anastomosis using an end-to-end anastomosis (EEA) stapler. A fatal anastomotic leak occurred in the first two patients and seven other patients died in the early postoperative period from respiratory and cardiovascular complications. Four other patients developed fibrotic strictures between 6 and 24 months after their operation. The strictures were easily dilated and did not recur. The use of an EEA stapler is recommended because it reduces the operating time, the incidence of anastomotic leaks, and probably the blood loss. The majority of anastomoses can be accomplished exclusively through the left chest by using the stapler.
Objective-To evaluate the long term results of coronary reoperations for recurrent angina with internal mammary (thoracic) arteries versus vein grafts. Design-Inception cohort of 103 patients with a mean follow up of 7.1 years (range 1.0-11.6). Setting-Regional cardiothoracic centre. Patients-Among 103 consecutive patients, mean (SD) age 61.8 (9.7) years, who were reoperated for recurrent angina between January 1982 and December 1991, 53 patients had unilateral or bilateral internal mammary artery (IMA) grafting supplemented or not with saphenous vein (SV) grafts (group A), and 50 patients underwent reoperative coronary surgery using SV grafts only (group B). The two groups were comparable in terms of demographic and clinicopathological data. Measurements and results-Operative mortality was 5.6% (95% confidence interval 4.6 to 6.6) for group A, and 10% (8.2 to 11.8) for group B (p > 0.05). Probability of freedom from new recurrence of angina was 86% at 5 and 10 years in group A, compared with 56% and 25% respectively in group B (p = 0.005). Freedom from cardiac events was estimated to be 81% at 5 and 10 years in group A, v 52% and 20% for group B, respectively. Actuarial survival was 95% v 93% at 3 years, 95% v 85% at 5 years, and 88% v 71% at 10 years after reoperation (p > 0.05). Conclusions-The long term results of IMA are superior to SV grafts in terms of freedom from new recurrence of angina and other cardiac events. The IMA is thus the conduit of choice in coronary revascularisation. (Heart 1998;80:9-13) Keywords: coronary artery bypass; coronary reoperation; recurrent angina; internal thoracic (mammary) artery During the past 20 years in coronary artery surgery, the most important development has been the employment of the internal mammary artery (IMA) as a conduit. 1 The IMA has been found to be a superior conduit in first time coronary artery bypass grafting (CABG); compared with vein conduits, it has significantly reduced hospital mortality and probability of coronary artery reoperation.2-4 Furthermore, when reoperation is indicated because of the failure of other grafts or progressive atherosclerosis, a patent IMA does not increase the risk of reoperation and additional IMA grafting at reoperation does not increase the hospital morbidity or early mortality.
5Although most surgeons appreciate that the IMA is the conduit of choice in the primary operation, there is reluctance to use IMA grafts in reoperations (which play an increasing role in coronary artery surgery) on patients in whom neither IMA, or only one, was used at the first operation. Previous studies 6-14 have addressed the eYcacy and role of IMA grafts in repeat CABG, but there is still limited documentation of the long term results-at 10 years-by means of actuarial survival and event-free probability. In this report, we compare the early and late results of IMA versus saphenous vein grafting in reoperations for recurrent angina, and concentrate on the freedom from cardiac events, long term survival, and the probability of further...
of Physiology, 1964, 207, 826. Steinhausen, M., Pflugers Archiv fur die gesamte Physiologie des Menschen und der Tiere, 1963, 277, 23. Steinhausen, M., Pflugers Archiv fur die gesamze Physiologie des Menschen und der Tiere, 1964, 279, 195.
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