Related Experiment Videos
[Recent trends in cardiac surgery for acquired heart disease]
Insights
This study addresses challenges in cardiac surgery for acquired heart diseases, including extended indications for aortocoronary bypass grafting (ACBG) in patients with poor left ventricular function and managing ischemic heart disease (IHD) alongside other surgeries.
Area of Science:
- Cardiovascular Surgery
- Acquired Heart Diseases
Context:
- Discusses recent challenges in cardiac surgery for acquired heart diseases.
- Highlights the increasing incidence of ischemic heart disease (IHD) in patients undergoing general surgery.
- Addresses the management of patients with concurrent IHD and other conditions requiring surgery.
Purpose:
- To review and discuss contemporary issues and outcomes in cardiac surgery for acquired heart diseases.
- To evaluate the extended indications for aortocoronary bypass grafting (ACBG) in patients with compromised left ventricular function.
- To assess the safety and efficacy of simultaneous ACBG and valvular surgery, and the impact of preoperative left ventricular function on aortic valve replacement outcomes.
Summary:
- Indication for ACBG has expanded to include patients with poor left ventricular function.
- Successful surgical interventions were performed on patients with IHD preceding general surgery (e.g., malignant tumors, aortic aneurysms).
- Doppler echography proved useful for monitoring carotid artery blood flow during extracorporeal circulation.
- Simultaneous ACBG and valvular surgery were performed in 8% of patients over 40 undergoing valvular surgery.
- Poor preoperative left ventricular function (ejection fraction ≤ 0.35, LVESVI ≥ 200 ml/m²) was associated with cardiac mortality after aortic valve replacement.
Impact:
- Demonstrates the feasibility of extended ACBG indications and successful management of complex cases.
- Highlights the importance of intraoperative monitoring techniques like Doppler echography.
- Identifies preoperative left ventricular function as a critical predictor of outcomes in aortic valve replacement, guiding surgical decision-making.
Abstract:
Some recently developed problems in cardiac surgery for acquired heart diseases, in our department, have been discussed in this paper. Ischemic heart disease (IHD): Indication for aortocoronary bypass grafting (ACBG) has been extended for the patients with poor left ventricular function. The number of the patients, who are found to have IHD before general surgery have been increased. Surgical treatments for these patients, five with malignant tumor, and two with aneurysm of the descending aorta, were performed 16 days to 4 months after ACBG without any operative death. In three patients with lesions of carotid arteries, blood flow of the carotid arteries was monitored with doppler echography, which was found useful for this purpose, during extracorporeal circulation. One hundred and four patients, over 40 years old, for valvular surgery, had coronary angiography at the cardiac catheterization between 1982-1983. Nine patients (8%) had significant IHD. They had ACBG and valvular surgery simultaneously. Valvular heart disease (VHD): Long-term results following aortic valve replacement have showed that 6 deaths were of cardiac origin. Five of them were with poor preoperative left ventricular function (ejection fraction: 0.35 or less, left ventricular endsystolic volume index: 200 ml/m2 or more) which might be indices for indication of surgical treatment for aortic regurgitation.