AORTIC VALVE REPLACEMENT IN PATIENT WITH FUNCTIONING CORONARY ARTERY BYPASS GRAFTS

We report the clinical case of aortic valve replacement for severe aortic insufficiency in patient who previously was subjected to coronary bypass grafting, with functioning grafts, including internal thoracic artery graft. The procedure was performed from the upper ministernotomy with peripheral (femoral) cardiopulmonary bypass

Outcomes of the minimally invasive aortic valve replacement

The OBJECTIVE was to demonstrate clinical outcomes of minimally invasive aortic valve replacement (MIAVR).MATERIAL AND METHODS. We retrospectively analyzed surgical results of treatment of patients underwent isolated AVR in our Institution between 2006 and 2018. Overall number of operations was 122; 56 of patient were operated via upper ministernotomy approach. Preoperative characteristics were similar in both groups.RESULTS. In our series MIAVR procedures had prolonged CPB and aortic cross clamping time, what significantly contributed to the increase in manifestations of heart failure in the early postoperative period, but didn’t affect the perioperative mortality and major morbidity rates. MIAVR led to reduction in postoperative blood loss and perioperative red blood cell transfusion rate. Most severe complications occurred in frail patients older than 75 years, and in those with extensive aortic annular calcification.CONCLUSION. MIAVR was the safe and reproducible surgical intervention and rarely led to significant complications in low-risk patients. Prolonged CPB time adversely affected the frequency of significant complications, especially in elderly patients. Although, selected high risk patients might benefit with MIAVR

ANGIOGRAPHIC EVALUATION OF GRAFT PATENCY AFTER MINIMALLY INVASIVE MULTIVESSEL CORONARY BYPASS SURGERY

The OBJECTIVE was to demonstrate perioperative outcomes and angiographic graft patency rates in the mediumterm period in patients after multivessel minimally invasive coronary artery bypass grafting (MICS CABG) procedures.MATERIAL AND METHODS. In the period from 2014 to 2019, 270 patients with stable forms of coronary artery disease were operated on. All patients received left internal thoracic artery (LITA) and venous or arterial (radial artery) grafts. Off-pump surgery was performed in 264 cases (97.8 %). 127 patients underwent CT-bypass angiography (CT-BA) on a 128-slice computed tomography at least after 1 year after the operation. Mean follow-up duration was (30.3±7.9) months.RESULTS. All patients received full myocardial revascularization. Mean number of grafts was (2.6±0.5). Perioperative mortality rate was 0.4 % (1 patient). Perioperative myocardial infarctions or cerebrovascular accident occurred in 3 (1.1 %) and 1 (0.4 %) patients. Overall graft patency rate in examined patients was 89.8 % (290 of 323). At the time of LITA, the patency of mammary grafts was 98.4 % (124 of 126), venous graft –84.0 % (163 of 194) and radial artery grafts – 100 % (3 of 3).CONCLUSION. MICS CABG was safe and effective and was characterized by minimal rate of perioperative complications. This procedure allowed to achieve complete revascularization of the myocardium without sternotomy and could be performed off-pump (in most cases). MICS CABG provide excellent long-term graft patency rates.The authors declare no conflict of interest.The authors confirm that they respect the rights of the people participated in the study, including obtaining informed consent when it is necessary, and the rules of treatment of animals when they are used in the study. Author Guidelines contains the detailed information