Operative Outcome of Cardiac Surgery in Patients with Liver Cirrhosis

Introduction: A retrospective study was performed to investigate the relationship between the severity of liver cirrhosis and the outcome of cardiac surgery. Methods and Results: Twenty-one patients with liver cirrhosis underwent cardiac surgery in our institution. According to the Child-Pugh classification, 13 patients were in class A, 7 in class B, and 1 in class C. Coronary artery bypass grafting was performed in 7 patients, surgery for valvular disease in 10 and other procedures in 4. Major postoperative complications occurred in 8%, 29%, and 100% for Child-Pugh class A, B, and C, respectively. Preoperative hemoglobin level was significantly lower in the patients with postoperative complications. None of 4 patients underwent coronary revascularization using off-pump procedure or mini-pump system experienced major complication. The operative mortality was 0%, 14%, and 0% for Child-Pugh class A, B, and C, respectively. Conclusions: Although the overall mortality rate in patients with liver cirrhosis was acceptable in our study, the incidence of severe complications, such as prolonged ventilation, mediastinitis and irreversible hepatic insufficiency was problematic in Child-Pugh class B and class C patients. Application of less invasive cardiac surgery, such as mini-pump system or off-pump procedure will improve the operative outcome in such patient group.長崎大学学位論文 学位記番号:博（医）甲第1,272号学位授与年月日:平成20年7月16

Surgical experience with chronic constrictive pericarditis

Objective: Constrictive pericarditis is a disease characterized by marked thickening of the pericardium which causes restriction of diastolic cardiac function. The purpose of this report is to review the outcome of pericardiectomy for constrictive pericarditis and to discuss its problems. Methods: Sixteen consecutive patients who underwent pericardiectomy for constrictive pericarditis in our institution between March 2000 and June 2011 were reviewed. All patients underwent decortication including at least the anterior surface from the right atrium to the left phrenic nerve and the diaphragmatic surface of the heart. The epicardium was concomitantly resectioned because it was usually sclerotic and constrictive. Results: Postoperatively, mean central venous pressure decreased to 8.8 ± 3.1 mmHg and was significantly lower than the preoperative value 15.3 ± 3.7 mmHg (p < 0.001). The mean postoperative duration of hospitalization was 25.6 ± 13.5 days. There were 2 in-hospital deaths and early mortality rate was 12.5 %; however, excluding hospital deaths, there were no significant postoperative complications and all survivors recovered and maintained good cardiac function during the mean follow-up period of 3.7 ± 2.8 years. Conclusion: For an acceptable outcome, surgical intervention should be performed at an appropriate time and the pericardiectomy should have proper scope and depth to prevent irreversible changes in the heart, liver, and other organs

Vacuum-assisted closure therapy for salvaging a methicillin-resistant Staphylococcus aureus-infected prosthetic graft

Infection of a vascular prosthesis after a bypass surgery is relatively rare. However, once developed, serious complications can occur, such as bleeding, sepsis, and organ ischemia, occasionally resulting in leg amputation or even death in some cases. The treatment of a vascular prosthesis infection involves the necessary removal of the infected graft, subsequently, an extra-anatomical bypass surgery is often considered. We herein report a case in which postoperative methicillin-resistant Staphylococcus aureus infection caused dehiscence of the femoral vessels and exposure of the graft vessel and anastomosed area. The infected tissue was surgically removed (debridement), and the patients condition was successfully treated by the application of a nonadherent dressing and vacuum-assisted closure therapy combined with the bridging technique

Vacuum-assisted closure therapy for salvaging a methicillin-resistant Staphylococcus aureus-infected prosthetic graft

Infection of a vascular prosthesis after a bypass surgery is relatively rare. However, once developed, serious complications can occur, such as bleeding, sepsis, and organ ischemia, occasionally resulting in leg amputation or even death in some cases. The treatment of a vascular prosthesis infection involves the necessary removal of the infected graft; subsequently, an extra-anatomical bypass surgery is often considered. We herein report a case in which postoperative methicillin-resistant Staphylococcus aureus infection caused dehiscence of the femoral vessels and exposure of the graft vessel and anastomosed area. The infected tissue was surgically removed (debridement), and the patient's condition was successfully treated by the application of a nonadherent dressing and vacuum-assisted closure therapy combined with the bridging technique

Isolated undersized mitral annuloplasty for functional mitral regurgitation in non-ischemic dilated cardiomyopathy: reconsideration of the relationship between preoperative coaptation depth and persistent mitral regurgitation.

A preoperative coaptation depth (CD) >or=11 mm is apparently a predictive factor for persistent mitral regurgitation (MR) after undersized mitral annuloplasty for functional MR. The results of studies of isolated undersized mitral annuloplasty in non-ischemic dilated cardiomyopathy (DCM) are reported, including the relationship between the preoperative CD and recurrent MR

Influence of the extent of aortic replacement on survival and quality of life in patients with aortic root replacement

Background: The influence of the extent of aortic replacement on the aortic root replacement is unclear. We investigated the clinical outcomes of the aortic root replacement in terms of the extent of aortic replacement and evaluated quality of life (QOL) after surgery.Methods: Thirty six patients were enrolled in this study. The mean age was 59.0 ± 13.1 years. The 36 patients were divided into three groups according the extent of aortic replacement: 21 patients with replacement of the ascending aorta (SB), 7 patients with hemi-arch replacement (HB), and 8 patients with total aortic arch replacement (TB). Postoperative health-related QOL was evaluated by SF-36 Version 2.Results: The hospital mortality in the 36 patients was 2.8%. The patient (TB) died from fungal infection of the prosthetic graft. Three late deaths (8.6%) were observed: cerebral hemorrhage in one (SB), pneumonia in one (SB), and unknown in one (HB). The 5-year survival was 94.1 ± 5.7% in the SB group, 100% in the HB and 87.5 ± 11.7% in the TB groups, respectively (p=0.84). One patient (4.8%) in the SB group had an aorta-related event 7 years after surgery. No patinets had aorta-related events in both the HB and the TB groups. There was no significant difference in postoperative health-related QOL among the three groups.Conclusions: Aortic root replacement at our hospital achieved excellent results. Neither long-term survival nor postoperative QOL differed significantly according to the extent of aortic root replacement. We plan to extend the present study by including a larger number of subjects