Multi-vessel coronary artery disease constitutes 30 to 60 % of morbidity of coronary heart disease (CHD). Surgical revascularization in patients with multi-vessel coronary artery disease is still a challenge. To evaluate the immediate results of hospital period: 30-day hospital mortality, postoperative complications and outcomes at 1 year follow-up the retrospective study was performed. We analyzed 90 patients with history of coronary artery disease who underwent coronary artery bypass grafting (CABG) surgery in 2014 by using the method of continuous sampling on the basis of a computer database of cardiac surgery department.It was established, that surgical revascularization in patients with multi-vessel coronary disease can bring complete revascularization, eliminate signs of stenocardia, improve the quality of life and exercise tolerance in most patients in the 30-day period, and in 1 year after surgery.
The Ross procedure was first proposed by Donald Ross in 1967. Numerous studies show excellent long-term outcomes of the Ross operation. One of its disadvantages is the intervention on two valves due to pulmonary homograft dysfunction.Aim. To study long-term outcomes of pulmonary homograft use after Ross operation (cumulative incidence of pulmonary homograft dysfunction, freedom from reoperation on pulmonary homograft, long-term survival, predictors of pulmonary homograft dysfunction) using data from one Russian center.Material and methods. A retrospective study included patients aged 18 years and older with aortic valve disease who underwent Ross procedure from April 2009 to December 2020 by a single surgeon. The age of the patients was 35 (26-44) years (men, 159 (75%)). Infective endocarditis as a cause of aortic valve pathology was diagnosed in 55 (26%) patients. Bicuspid aortic valve was diagnosed in 131 (62%) patients. The median follow-up period was 79 (26,5102,7) months.Results. Combined interventions were performed in 40 cases (18,9%). The modified Ross procedure was used in 54 (25,5%) cases (intra-aortic — 29, using Dacron tube graft — 25). Inhospital mortality was 0,5%. The 5- and 10-year allcause survival rates were 98,5% and 95,4%, while the 10-year cumulative pulmonary valve reoperation rate and pulmonary homograft dysfunction was 4,6% and 35,2%, respectively. The only factor affecting pulmonary homograft dysfunction was patient age ≤30 years (odds ratio =0,2 with 95% confidence interval: 0,06-0,7; p=0,02).Conclusion. Fresh pulmonary homografts have a low incidence of dysfunction and reintervention after Ross procedure. Young age is the only independent risk factor for pulmonary homograft dysfunction.
We conducted this study to identify current trends and risk factors for iatrogenic dissection. Methods: From December 2013 to November 2017 in Republican Research Center for Emergency Medicine, 711 patients (mean age 54+∕-2,3 years old) were operated electively. Off-pump coronary artery bypass grafting procedures was performed in all cases. Patients' preoperative risk factors, and operative and postoperative courses were analyzed from the hospital records retrospectively. Results: Of the 711 patients, who had off-pump coronary artery bypass, 2 (0.28%) developed iatrogenic intraoperative aortic dissection. Patients with the iatrogenic aortic dissection were in older age group (62 and 68 years old). Both patients had dissection extending beyond the aortic arch. IAAD was identified after removing the side clamp from the aorta in both patients; however, the intimal tear was located on the site of proximal anastomosis. Preoperatively, 2 (100%) patients had arterial hypertension and ascending aorta atherosclerosis. No other significant risk factors could be identified. One patient died due to intraoperative complete aortic rupture. In another case the dissected segment was replaced with a graft and proximal anastomoses were replanted in it under the hypothermic circulatory arrest. This patient required inotropic and respiratory support postoperatively. Mortality rate was 100%, second patient died due to respiratory distress on 10 th postoperative day. Conclusions: Intraoperative aortic dissection is an unpredictable and often fatal complication of cardiac surgery. Regarding to our data overall incidence of iatrogenic type A aortic dissections was 0,28%. Increased age, high blood pressure and atheromatous disease of the ascending aorta could be significant risk factors for iatrogenic dissection in our series. Surgical interventions for iatrogenic aortic dissections require further improvement of surgical techniques and perioperative management.
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