Left main disease management strategy: Indications and revascularization methods in particular groups of subjects

Surgical revascularization with coronary artery by-pass grafting is still recommended in vast majority of patients with unprotected left main disease. The aim of the paper was to analyze optimal treatment of left main disease in selected groups of patients, on the basis of current guidelines and information gained from literature data. We focused on data in relation to treatment of elderly patients, diabetics and those hemodynamically unstable. Additionally we discussed the issue of anti-platelet therapy and informed consent. As far as efficacy of treatment is concerned, not only method of revascularization but also general condition of the patient, the factors influencing peri-operative risk and optimal pharmacotherapy should be taken into account. Therefore establishment of the heart team is crucial when choosing the most suitable method of invasive treatment of left main disease

Porównanie wczesnej rehabilitacji szpitalnej chorych leczonych metoda pomostowania naczyń wieńcowych bez krażenia pozaustrojowego, z tzw. małego dostępu, z chorymi po klasycznej rewaskularyzacji serca – doświadczenia własne

There is some evidence that focused and intense rehabilitation improve clinical outcome following conventional open-heart surgery. Recent developments in surgical techniques, which focused on the improvement in patient comfort, reduction in hospital stay and costs, has resulted in minimally invasive techniques, including Minimally Invasive Direct Coronary Artery Bypass (MIDCAB) and Endoscopic Atraumatic Coronary Artery Bypass (EACAB). EACAB is safer than on-pump coronary artery bypass graft (CABG), especially in high risk patients. Its use, however, is limited to a small subgroup of patients: those with suitable anatomy of coronary pathology, younger patients with rapidly progressing coronary artery disease or elderly patients with substantial co-morbidities, whom sternotomy and cardiopulmonary bypass pose significant risks to. In this latter group of patients, effective rehabilitation is, therefore, even more important. Prevention of disturbances in homeostasis resulting from reduced physical activity, and thus rate of recovery and effectiveness of cardiac surgery, are not dependent on early physical activity and the intensiveness of the inpatient rehabilitation only but also on psychological therapy, dietary advice and health-promoting education. In this study, we explore differences in inpatient rehabilitation methods and outcomes between the groups of patients who underwent on-pump CABG and MIDCAB operations. Our data show that inpatient rehabilitation following MIDCAB operations may be shorter than after on-pump CABG by 2 days on average

Replacement of the Ascending Aorta, Aortic Root and Valve with a Novel Stentless Valved-Conduit

Purpose:- Biological valved-conduit grafts avoid the need for anticoagulation, and can exploit the excellent hemodynamic performance of stentless valves. Incorporation of sinuses of Valsalva into the neoaortic root can improve the function of the stentless valves. Description:- Here we present a novel prefabricated stentless valved-conduit incorporating sinuses of Valsalva and describe the technique of inplantation. The BioValsalva™ valved-conduit incorporates a stentless porcine aortic valve (Vascutek Elan™) suspended within a triple-layered vascular conduit (Triplex™, Vascutek, Renfrewshire, Scotland) constructed with sinuses of Valsalva. Evaluation:- The BioValsalva™ valve-conduit was used in twelve patients with aortic regurgitation due to annuloaortic ectasia unsuitable for aortic valve repair and concomitant ascending aorta aneurysm with no mortality and excellent functioned result. Conclusion:- The prefabricated, composite stentless-valved-conduit, which material is hemostatic and reduces bleeding, is easy to implant with short ischemic time, and lends itself well to a variety of insertion techniques