LVA repair with Dor procedure can be performed with low mortality. With appropriate repair of LVA and coronary revascularization, patients may have benefit both for survival and also for clinical status.
Chronic thromboembolic pulmonary hypertension (CTEPH) is a potentially correctable cause of secondary pulmonary hypertension. Surgical treatment remains the primary treatment for patients with CTEPH. Pulmonary thromboendarterectomy (PEA) with deep hypothermic circulatory arrest is the standard and recommended surgical technique for the treatment of these patients. The prevalence of CTEPH after an acute pulmonary thromboembolism (PTE) has been found in various studies to be between 0.6 and 8.8%. Mortality rates in elective PEA cases with CTEPH are reported to be between 1.9 and 4.5%. We report on a 50-year-old female patient with combined inherited thrombophilia, including protein C and protein S deficiencies, who was diagnosed with CTEPH and was successfully treated with pulmonary thromboendarterectomy.
Introduction
Median sternotomy is the most preferred approach in heart surgery.
Post-sternotomy mediastinitis is a catastrophic and potentially
life-threatening complication with an incidence rate of 0.15% to 5%, and its
overall mortality rate reaches 47%. In this study, we aimed to compare the
results of vacuum-assisted closure technique and the conventional methods on
the management of mediastinitis following isolated coronary artery bypass
graft surgery.
Methods
Between February 2001 and July 2013, 32,106 patients who underwent cardiac
operations were evaluated retrospectively. One hundred and fourteen patients
who developed post-sternotomy mediastinitis were included in this study. The
patients were divided into two groups and compared - vacuum-assisted closure
group (n=52, 45.6%) and conventional treatment group (n=62, 54.4%).
Results
There were no differences between the two groups according to the patients’
characteristics, surgical data, and mediastinal cultures. However, we found
that total treatment duration for post-sternotomy mediastinitis, time
interval from diagnosis to negative culture, hospitalization time, and
in-hospital mortality were statistically significantly lower in the
vacuum-assisted closure group than in the conventional treatment group
(P<0.001, P<0.001, P<0.001, and P=0.03, respectively).
Conclusion
This study demonstrates that the vacuum-assisted closure technique improves
the medical outcome of patients with post-sternotomy mediastinitis compared
with the conventional treatment. The vacuum-assisted closure is a safe and
more effective treatment modality for patients with post-sternotomy
mediastinitis after cardiac surgery with reasonable morbidity and
mortality.
Reduction of the diameter of STJ can be used to treat AI in patients with ascending aortic aneurysm with nearly normal aortic cusps. Midterm results of this procedure are encouraging.
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