H Takahashi

Long-term results after surgical treatment of postinfarction ventricular septal rupture

OBJECTIVESnPostinfarction ventricular septal rupture is a serious complication associated with high hospital mortality rates. The present study aimed to identify predictors of early and late outcome in patients with postinfarction ventricular septal defect over a period of 30 years.nnnMETHODSnWe retrospectively analysed clinical and operative data, predictors of early mortality and long-term survival in a series of 52 consecutive patients (male, n = 26; mean age, 67 ± 10 years) with postinfarction ventricular septal rupture that was surgically repaired at our institution between September 1982 and December 2012. The overall logistic EuroSCORE was 41 ± 24% and the follow-up rate was 100%.nnnRESULTSnThe 30-day mortality rate was 36% (n = 19), and these 19 survivors were followed up for a mean of 7.8 ± 7.7 (median, 6.0) years. The actuarial survival rates of these 19 patients at 1, 5 and 10 years were 91, 75 and 31%, respectively. Univariate predictors of 30-day mortality comprised renal insufficiency, shock at surgery, emergency surgery, logistic EuroSCORE, three-vessel disease, significant left circumflex coronary arterial stenosis, significant right coronary arterial stenosis, incomplete revascularization, surgical duration and cardiopulmonary bypass time and multivariate analysis selected only incomplete coronary revascularization as an independent risk factor of 30-day mortality.nnnCONCLUSIONSnEarly mortality rates after surgical repair of postinfarction septal rupture remained poor in this series. Most patients who survived for <30 days had a preoperative shock status. Preoperative improvement in shock status and aggressive coronary revascularization are mandatory for patients with ventricular septal rupture.

Surgical Treatment of Aortic Valve Endocarditis With Left Ventricular-Aortic Discontinuity

BACKGROUNDnThe periannular expansion of infection is a serious complication of infective endocarditis associated with high morbidity and mortality. The present study evaluates the results of aortic annular reconstruction in active infective endocarditis with left ventricular-aortic discontinuity.nnnMETHODSnLeft ventricular-aortic discontinuity was diagnosed by echocardiography in 25 (21 men, 4 female; mean age 60.2 ± 13.2 years) of 269 patients who underwent surgery for active native or prosthetic aortic valve endocarditis between January 2001 and October 2011. Seventeen (68%) and 8 (32%) patients had native and prosthetic valve endocarditis, respectively. Aortic root abscesses were radically debrided in all patients. The aortic annulus was reconstructed using autologous pericardium in 20 patients and a Dacron patch in 2. Isolated aortic valves were replaced with a bioprosthesis in 9 (36%) patients and a mechanical prosthesis in 13 (52%). Mechanical composite grafts were implanted in 3 (12%) patients. The mean follow-up was 29.1 ± 23.6 months and complete.nnnRESULTSnThirty-day mortality was 20% (n = 5). Survival at 3 years was 80% ± 8% with no significant difference between native and prosthetic valve endocarditis (log-rank, p = 0.69). Endocarditis did not recur during follow-up.nnnCONCLUSIONSnDespite procedural progress, surgery for aortic valve endocarditis with left ventricular-aortic discontinuity remains associated with significant in-hospital mortality, but mid-term survival after the perioperative period is good. Annular reconstruction with a pericardial patch is technically safe.

Facilitated Aortic Valve Replacement with Complete Sternotomy and Minimal Skin Incision Using Endoscopy: A Case of Surgical Report

Although median sternotomy is the accepted approach to the heart for cardiac surgery, minimally invasive approaches including partial sternotomies have recently been developed. However, such strategies might lead to sternal overriding, instability, and fracture or division of the internal thoracic arteries. Furthermore, a full sternotomy would be required to address unpredictable intra- or postoperative complications. This article describes minimally invasive aortic valve replacement via full sternotomy and minimal skin incision using an endoscope.

Management of Biventricular Assist Device Implantation in Patients with Necrotic Pancreatitis

This report describes the management of biventricular assist device (BIVAD) implantation in a patient with necrotic pancreatitis. BIVADs provide mechanical support for ventricular ejection in the failing heart and have become an accepted treatment for end-stage heart failure. They also have proved to be a successful bridge to heart transplantation. As their popularity has grown, the number of patients with BIVADs presenting for noncardiac surgery is increasing. We report the successful management of an implanted extracorporeal BIVAD in a patient with end-stage heart failure and with pancreatic stents in a case of necrotic pancreatitis. Historical, physical, laboratory, and imaging data allowed conservative management leading to a favorable outcome.