Outcome of Surgery for Ischemic Mitral Regurgitation Depends on the Type and Timing of the Coronary Revascularization

Objective: Long-term outcomes of mitral valve (MV) repair versus MV replacement for ischemic mitral regurgitation (IMR) in patients undergoing either prior (PCR) or concomitant coronary revascularization (CCR) by surgery (CABG) or intervention (PCI) are uncertain. Methods and Results: Of 446 patients receiving MV surgery for IMR between July 2006 and December 2010, 125 patients—87 CCR (69.1%) and 38 PCR (30.9%)—were eligible for inclusion in the study. Survival was higher in CCR versus PCR at long-term follow-up (78.83% vs. 57.9%, p = 0.016). The incidence of MACCE was lower in the CCR compared to PCR at both hospital discharge (34.11% vs. 63.57%, p = 0.003) and at follow-up (34.11% vs. 65.79%, p = 0.0008). Patients receiving CABG or CABG with PCI in PCR had higher mortality risks after MV surgery than CCR patients (X2 = 6.029, p = 0.014 and X2 = 6.466, p = 0.011, respectively). Whereas in the PCR group, MV repair and MV replacement achieved similar survival probability (X2 = 1.551, p = 0.213), MV repair in the CCR group led to improved survival compared to MV replacement (X2 = 3.921, p = 0.048). In MV replacement, LAD-CABG improved survival compared to LAD-PCI (U = 15,000.00, Z = ?2.373 p = 0.018), and a substantial impact of arterial IMA-LAD grafting was revealed in the Cox-regression analysis (HR 0.334, CI: 0.113–0.989, p = 0.048) as opposed to venous-LAD grafting (HR 0.588, CI: 0.166–2.078, p = 0.410). Conclusion: Early treatment of IMR concomitant to coronary revascularization enhances long-term survival compared to delayed MV surgery after PCR. MV repair is not superior to MV replacement when performed late after coronary revascularization; however, MV repair leads to better survival than MV replacement when performed concomitantly with CABG with arterial LAD revascularization

Impact of Adjunct Femoral Patch Reconstruction on Graft Patency after Below the Knee Popliteal Bypass Implantation

Introduction: Acknowledging the superior long term patency of infrainguinal saphenous bypass to distal popliteal artery, debate continues regarding the choice of alternative conduits and possible surgical adjuncts to improve inflow and graft salvage. The objective of this retrospective study was to determine the effectiveness of proximal anastomotic patch as adjunct to open surgical below the knee popliteal revascularization.Material and Methods: In a series of 132 distal popliteal bypass operations 63 non-reversed vein, 18 in situ vein and 51 Omniflow bypass conduits were used. Proximal anastomotic patch was applied in overall 28 patients: 19% in the non-reversed (12 patients), 50% in the in situ group (9 patients) and 13.7% in the Omniflow group (7 patients).Results: The reintervention rate was 7.9% in the non-reversed, 33.3% in the in situ and 31.4% in the Omniflow group. The most often complication was the proximal anastomotic stenosis (5.3%), followed by bleeding (3%), infection (1.5%) and distal anastomotic stenosis (1.5%). Patch reconstruction did not decrease incidence of reoperation (21.4% vs. 21.2% in the non-patch group), nor significantly influence bleeding, infection or thrombosis, however it reduced the overall rate of proximal anastomosis stenosis (0% vs. 6.7%, p=) and significantly improved patency rate at 3 years in the in situ group compared to the non-patch group (100% vs. 55.6%, p=0.02).</p

Video-assisted minimal access surgery for complicated mitral valve endocarditis, tricuspid valve insufficiency and progressive coronary disease after previous CABG - in the time of COVID-19: a case report

Background!#!The timing for heart surgery following cerebral embolization after cardiac valve vegetation is vital to postoperative recovery being uneventful, additionally Covid-19 may negatively affect the outcome. Minimally invasive methods and upgraded surgical instruments maximize the benefits of surgery also in complex cardiac revision cases with substantial perioperative risk.!##!Case presentation!#!A 68 y.o. patient, 10 years after previous sternotomy for OPCAB was referred to cardiac surgery on the 10th postoperative day after neurosurgical intervention for intracerebral bleeding with suspected mitral valve endocarditis. Mitral valve vegetation, tricuspid valve insufficiency and coronary stenosis were diagnosed and treated by minimally invasive revision cardiac surgery on the 14th postoperative day after neurosurgery.!##!Conclusion!#!The present clinical case demonstrates for the first time that the minimally invasive approach via right anterior mini-thoracotomy can be safely used for concomitant complex mitral valve reconstruction, tricuspid valve repair and aorto-coronary bypass surgery, even as a revision procedure in the presence of florid endocarditis after recent neurosurgical intervention. The Covid-19 pandemic and prophylactic patient isolation slow down the efficacy of pulmonary weaning and mobilisation and prolong the need for ICU treatment, without adversely affecting long-term outcome

Effect of Haemodynamic Changes on Epithelium-related Intestinal Injury in Off-pump Coronary Surgery.

OBJECTIVES: Intestinal injury is thought to play a central role in the occurrence of multiorgan dysfunction after on-pump coronary surgery. Clinical benefits of off-pump revascularisation remain, however, controversial. MATERIAL AND METHODS: Hepatic enzymes and plasmatic IL-6, IL-8 and intestinal-type fatty acid binding protein (I-FABP) were determined in 20 patients (age 65-75) undergoing either on-pump (n=10) or off-pump (n=10) coronary surgery. Haemodynamic and biochemical parameters, catecholamine and volume therapy were monitored. RESULTS: Central venous pressure (CVP) was significantly higher in the off-pump group during and 12h after operation (9.5+/-1.35 vs. 6.21+/-0.63mmH2O, p=0.012). Higher GGT and GLDH levels occurred in the off-pump group and correlated with the elevated I-FABP levels at 24h (935.8+/-83.7 vs. 370.4+/-67.7pg/mL, p<0.001). CVP correlated with I-FABP peak values (Pearson's coefficient 0.852). IL-6 and IL-8 were released to a lower extent in the off-pump group compared to on pump (p<0.05) at 24h (139.3+/-27.7 vs. 279.4+/-56.2 and 15.3+/-7.4 vs. 38.5+/-13.8pg/mL) and at 72h post-operatively (4.5+/-2.1 vs. 30.1+/-12.1 and 7.8+/-1.2 vs. 17.1+/-5.2pg/mL). CONCLUSIONS: While inflammatory activation is reduced with CPB avoidance, elevated CVP during off-pump surgery is followed by temporary postoperative enterocyte damage that may threaten the normal function of the gastrointestinal system and lead - in certain groups of high risk patients - to irrecoverable injury