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Avoiding oversizing in sutureless valves leads to lower transvalvular gradients and less permanent pacemaker implants postoperatively. 避免无缝线瓣膜过大,可降低经瓣梯度,减少术后永久性起搏器植入。
4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2022-07-09 DOI: 10.1093/icvts/ivac157
Delphine Szecel, Marie Lamberigts, Filip Rega, Peter Verbrugghe, Christophe Dubois, Bart Meuris

Objectives: The aim of this study was to evaluate the impact of changing the sizing strategy in aortic valve replacement using the Perceval sutureless prosthesis on haemodynamic outcomes and postoperative pacemaker implantation.

Methods: Retrospective analysis of patients implanted with the Perceval valve between 2007 and 2019 was performed by comparing patients implanted before the modification of sizing strategy (OLD group) and after (NEW group). The outcome parameters evaluated were the implanted prosthesis size, haemodynamical profile and postoperative pacemaker implantation.

Results: The entire patient cohort (784 patients) consisted of 52% female patients, with a mean age of 78.53 [standard deviation (SD): 5.8] years and a mean EuroSCORE II of 6.3 (range 0.7-76). In 55.5% of cases, surgery was combined. The NEW cohort had more male patients (54.6% vs 43.4%) (P = 0.002). Mean implanted valve size, corrected for body surface area, was significantly lower in the NEW cohort (13.1, SD: 1.4 vs 13.5, SD: 1.4 mm/m2, P < 0.001). The 30-day mortality was 3.4%. Peak and mean transvalvular gradients at discharge were significantly lower in the NEW versus OLD groups: 24.4 mmHg (SD: 9.2) versus 28.4 mmHg (SD: 10.3) (P < 0.001) and 13.6 mmHg (SD: 5.3) versus 15.5 mmHg (SD: 6.0) (P < 0.001). The mean effective opening area and the indexed effective opening area, respectively, increased from 1.5 cm2 (SD: 0.5) and 0.85 cm2/m2 (SD: 0.27) in the OLD group to 1.7 cm2 (SD: 0.5) and 0.93 cm2/m2 (SD: 0.30) in the NEW group (P < 0.001). No difference was found in paravalvular leakage ≥1/4. Centrovalvular leakage ≥1/4 significantly decreased from 18% to 7.9% (P < 0.001). With the new sizing, the new postoperative pacemaker implantation rate decreased significantly from 11% to 6.1% (P = 0.016).

Conclusions: Correct sizing of sutureless aortic valves is crucial to obtain the best possible haemodynamics and avoid complications.

目的:本研究的目的是评估使用Perceval无缝线假体主动脉瓣置换术中改变大小策略对血流动力学结果和术后起搏器植入的影响。方法:回顾性分析2007年至2019年植入Perceval瓣膜的患者,比较改变大小策略前(OLD组)和改变大小策略后(NEW组)植入的患者。评估的结果参数是植入假体的大小、血流动力学特征和术后起搏器植入。结果:整个患者队列(784例)中女性患者占52%,平均年龄78.53岁[标准差:5.8]岁,平均EuroSCORE II为6.3(范围0.7-76)。55.5%的病例联合手术。新队列中男性患者较多(54.6% vs 43.4%) (P = 0.002)。经体表面积校正后的平均植入瓣膜尺寸在NEW队列中显著降低(13.1,SD: 1.4 vs 13.5, SD: 1.4 mm/m2, P)。结论:正确的无缝线主动脉瓣尺寸对于获得最佳血流动力学和避免并发症至关重要。
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引用次数: 9
Risk factors for postoperative pulmonary venous obstruction after surgical repair of total anomalous pulmonary venous connection: a systemic review and meta-analysis 全异常肺静脉连接手术修复术后肺静脉阻塞的危险因素:一项系统回顾和荟萃分析
4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2022-06-17 DOI: 10.1093/icvts/ivac162
Han Zhang, Guocheng Shi, Huiwen Chen
Abstract OBJECTIVES A meta-analysis was performed to investigate the risk factors for postoperative pulmonary venous obstruction (PVO) after surgical repair of total anomalous pulmonary venous connection (TAPVC). METHODS Data bases including PubMed, Embase, Web of Science and Cochrane Library were searched systematically. The goal was to discuss the risk factors for postoperative PVO after TAPVC. Publications were screened by 2 authors independently for criteria inclusion, methodological quality assessment and data extraction. The Newcastle-Ottawa Scale and the Agency for Healthcare Research and Quality checklist were obtained to assess the quality of the studies. Data were pooled by the random effect model or the fixed effect model according to the heterogeneity test. RESULTS A total of 16 studies (2,385 participants) were included in the meta-analysis. All included studies were retrospective studies. Six potential risk factors were pooled, 5 of which were significantly associated with postoperative PVO. Patients with preoperative PVO were more likely to suffer from postoperative PVO [odds ratio (OR)=5.27, 95% confidence interval (CI) = (2.75, 10.11), P < 0.01]. Compared with a sutureless procedure, the conventional operative procedure was associated with postoperative PVO [OR = 1.80, 95% CI=(1.20, 2.71), P < 0.01]. A mixed type TAPVC plays a critical role in postoperative PVO [OR = 3.78, 95% CI=(1.08, 13.18), P = 0.04]. Inverse variance analysis showed that longer cardiopulmonary bypass time [hazard ratio (HR)=1.01, 95% CI=(1.01, 1.02), P < 0.00001] and aortic cross-clamp time [HR = 1.01, 95% CI=(1.01, 1.02), P < 0.01] were significantly associated with postoperative PVO. Heterotaxy [OR = 1.18, 95% CI = 0.13, 10.45, P = 0.88] was not statistically significant as a risk factor for postoperative PVO. CONCLUSIONS This meta-analysis may provide a perspective on the risk factors for postoperative PVO after TAPVC, thus leading to more studies predicting postoperative PVO after TAPVC with our findings.
目的对全异常肺静脉连接(TAPVC)手术修复术后发生肺静脉阻塞(PVO)的危险因素进行meta分析。方法系统检索PubMed、Embase、Web of Science、Cochrane Library等数据库。目的是探讨TAPVC术后PVO的危险因素。出版物由2位作者独立筛选,包括标准纳入、方法学质量评估和数据提取。获得纽卡斯尔-渥太华量表和卫生保健研究机构质量检查表来评估研究的质量。根据异质性检验,采用随机效应模型或固定效应模型合并数据。结果荟萃分析共纳入16项研究(2385名受试者)。所有纳入的研究均为回顾性研究。共收集6个潜在危险因素,其中5个与术后PVO显著相关。术前有PVO的患者术后更容易发生PVO[优势比(OR)=5.27, 95%可信区间(CI) = (2.75, 10.11), P < 0.01]。与无缝线手术相比,常规手术与术后PVO相关[OR = 1.80, 95% CI=(1.20, 2.71), P < 0.01]。混合型TAPVC在术后PVO中起关键作用[OR = 3.78, 95% CI=(1.08, 13.18), P = 0.04]。反方差分析显示,较长的体外循环时间[危险比(HR)=1.01, 95% CI=(1.01, 1.02), P < 0.00001]和主动脉交叉夹持时间[HR =1.01, 95% CI=(1.01, 1.02), P < 0.01]与术后PVO显著相关。异位[OR = 1.18, 95% CI = 0.13, 10.45, P = 0.88]作为术后PVO的危险因素无统计学意义。结论:本荟萃分析可能为TAPVC术后PVO的危险因素提供了一个视角,从而使更多的研究与我们的研究结果一起预测TAPVC术后PVO。
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引用次数: 1
Are sequential compression devices routinely necessary following enhanced recovery after thoracic surgery? 在胸外科术后增强恢复后,是否常规需要序贯压迫装置?
4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2022-06-17 DOI: 10.1093/icvts/ivac165
S. Abdul, C. Anstee, P. Villeneuve, Sebatien Gilbert, A. Seely, S. Sundaresan, D. Maziak
Abstract OBJECTIVES The prominence of “enhanced recovery after surgery” (ERAS) protocols being adopted in thoracic surgery requires a re-evaluation of mechanical venous thromboembolism (VTE) prophylaxis guidelines. The goal of this study was to assess the role of sequential compression devices (SCD) in the prevention of VTEs such as deep vein thrombosis and pulmonary embolism (PE) in thoracic surgical patients. METHODS We identified 200 patients who underwent elective oncological thoracic surgery between December 2018 and December 2020 in 2 cohorts—1 with SCDs and 1 without (i.e. non-SCD). All patients followed a standardized enhanced recovery after surgery (ERAS) protocol. The quality of care provided by SCDs was evaluated by the incidence and severity of postoperative and follow-up VTEs. Cohorts were compared by the Caprini score (CS) and the Charlson Comorbidity Index (CCI) with a two one-sided t-test analysis. Secondary outcomes include perioperative characteristics and follow-up data. RESULTS Only 2 patients within the SCD group developed a PE with average CS and CCI metrics, both after hospital discharge and treated with anticoagulants, raising concern over the prophylactic nature of SCDs. The CS (6.9 ± 1.3 and 6.9 ± 1.5; P = 0.96) and the CCI (3.8 ± 2.0 and 4.1 ± 2.6; P = 0.33) for non-SCD and SCD, respectively, did not differ. The two one-sided t-test analysis for CS (P < 0.001) and CCI (P < 0.001) demonstrated equivalence. CONCLUSIONS Although larger studies are required to confirm these results, routine SCD use may not be required when implementing ERAS protocols because clinically significant VTE rates were minimal.
摘要目的“术后增强恢复”(ERAS)方案在胸外科手术中的突出地位要求对机械性静脉血栓栓塞(VTE)预防指南进行重新评估。本研究的目的是评估序贯压迫装置(SCD)在预防胸外科患者深静脉血栓形成和肺栓塞(PE)等静脉血栓栓塞(vte)中的作用。方法:在2018年12月至2020年12月期间,我们将200名接受选择性肿瘤胸外科手术的患者分为2组,1组患有scd, 1组没有(即非scd)。所有患者都遵循标准化的术后增强恢复(ERAS)方案。通过术后和随访静脉血栓栓塞的发生率和严重程度来评估scd提供的护理质量。采用双单侧t检验比较capryini评分(CS)和Charlson共病指数(CCI)。次要结局包括围手术期特征和随访数据。结果:SCD组中仅有2例患者在出院后和接受抗凝治疗后发生了CS和CCI指标平均的PE,这引起了人们对SCD预防性质的关注。CS分别为6.9±1.3和6.9±1.5;P = 0.96), CCI分别为3.8±2.0和4.1±2.6;P = 0.33),非SCD和SCD的差异无统计学意义。CS (P < 0.001)和CCI (P < 0.001)的两个单侧t检验分析证明了等效性。结论:虽然需要更大规模的研究来证实这些结果,但在实施ERAS方案时可能不需要常规SCD,因为临床显著的VTE发生率很小。
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引用次数: 0
Lockdown surgery: the impact of coronavirus disease 2019 measures on cardiac cases. 封锁手术:2019冠状病毒病措施对心脏病例的影响。
4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2022-06-15 DOI: 10.1093/icvts/ivac060
Felix Nägele, Clemens Engler, Michael Graber, Nina Remmel, Jakob Hirsch, Leo Pölzl, Rosalie Huber, Victor Schweiger, Juliane Kilo, Nikolaos Bonaros, Ivan Tancevski, Michael Grimm, Can Gollmann-Tepeköylü, Johannes Holfeld

Objectives: The need to ration medical equipment and interventions during the coronavirus disease 2019 pandemic translated to an ever-lengthening wait list for surgical care. Retrospective analysis of lockdowns is of high importance to learn from the current situation for future pandemics. This monocentric study assessed the impact of lockdown periods on cardiac surgery cases and outcomes.

Methods: The single-centre cross-sectional descriptive observational study was conducted to investigate the first lockdown period and the following post-lockdown period in comparison to the same periods during the previous 3 years at the Department of Cardiac Surgery at the Medical University of Innsbruck. Data were prospectively collected and retrospectively analysed from the department-specific quality management system. The primary objective was to compare the number of open-heart procedures between the prelockdown and the lockdown period. The secondary objectives were to analyse the characteristics and the outcomes of open-heart procedures.

Results: There were no differences in patient demographics. A significant decrease of 29% in weekly surgical procedures was observed during the lockdown period. The surgical case-mix was unaffected: The numbers of aortic valve replacements, coronary artery bypass grafts, mitral valve repair or replacement procedures and others remained stable. The urgency of cases increased significantly, and the general health conditions of patients appeared to be worse. However, outcomes were unchanged.

Conclusions: By implementing a rational patient selection process, the quality of open-heart procedures was maintained even though patients who underwent surgery during lockdown were sicker and more symptomatic.

在2019冠状病毒病大流行期间,对医疗设备和干预措施的配给需求导致等待手术治疗的名单越来越长。对封锁的回顾性分析对于从目前的情况中吸取教训,为未来的大流行做好准备具有重要意义。这项单中心研究评估了封锁期对心脏手术病例和结果的影响。方法:采用单中心横断面描述性观察性研究,对因斯布鲁克医科大学心脏外科的第一次封城期和封城后的封城期进行调查,并与前3年的同期进行比较。前瞻性地收集数据,并从部门特定的质量管理体系中进行回顾性分析。主要目的是比较锁定前和锁定期间的心脏直视手术数量。次要目的是分析开胸手术的特点和结果。结果:两组患者人口统计学无差异。在封锁期间,每周的外科手术数量显著减少了29%。手术病例组合未受影响:主动脉瓣置换术、冠状动脉旁路移植术、二尖瓣修复或置换手术及其他手术的数量保持稳定。病例的急迫性大大增加,患者的一般健康状况似乎更糟。然而,结果没有改变。结论:通过实施合理的患者选择过程,即使在封锁期间接受手术的患者病情更重、症状更严重,也能保持心内直视手术的质量。
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引用次数: 1
Erratum to: Analysis of 3-dimensional interventricular septum and abnormal muscle bundles models for septal myectomy. 室间隔肌切除术的三维室间隔和异常肌束模型分析。
4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2022-06-15 DOI: 10.1093/icvts/ivac093
Uladzimir Andrushchuk, Artsem Niavyhlas, Vitali Adzintsou, Iryna Haidzel, Hanna Model, Aliaksandr Shket
the
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引用次数: 0
Salvage debulking surgery and hyperthermic intrathoracic chemotherapy for massive recurrent mesothelioma in the mediastinum. 纵隔大面积复发间皮瘤的抢救性减容手术及胸内高温化疗。
4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2022-06-15 DOI: 10.1093/icvts/ivac034
Shi Sum Poon, Caterina Alberti, Marco Nardini, Marcello Migliore

Mediastinal malignant pleural mesothelioma with signs of tamponade is rare. Indication for reoperation for recurrent malignant pleural mesothelioma is a controversial but viable option in selected patients. We report a case of a 68-year-old man presenting with epithelioid malignant pleural mesothelioma who underwent a total of three debulking surgeries (pleurectomy/decortication) combined with hyperthermic intrathoracic chemotherapy. Five years after the first procedure, a third urgent operation was performed for recurrence of a large mediastinal mesothelioma causing acute symptoms of pericardial constriction and tamponade. The patient was alive for eight years since the first treatment and 36 months after the second reoperation.

摘要纵隔恶性胸膜间皮瘤有填塞征象是罕见的。复发性恶性胸膜间皮瘤的再手术指征是一个有争议但可行的选择。我们报告一个68岁的男性,以上皮样恶性胸膜间皮瘤,接受了三次减体积手术(胸膜切除/去皮),并结合胸内高温化疗。第一次手术五年后,第三次紧急手术是由于复发的大纵隔间皮瘤引起心包收缩和填塞的急性症状。患者自第一次治疗以来存活了8年,第二次再手术后存活了36个月。
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引用次数: 0
Novel brain computed tomography perfusion for cerebral malperfusion secondary to acute type A aortic dissection. 新型脑ct灌注诊断急性A型主动脉夹层继发脑灌注不良。
4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2022-06-15 DOI: 10.1093/icvts/ivac046
Yosuke Inoue, Manabu Inoue, Masatoshi Koga, Shigeki Koizumi, Koki Yokawa, Kenta Masada, Yoshimasa Seike, Hiroaki Sasaki, Kenji Yoshitani, Kenji Minatoya, Hitoshi Matsuda

Objectives: The management of acute type A aortic dissection with malperfusion syndrome remains challenging. To evaluate preoperative condition, symptoms might be subjective and objective evaluation of cerebral artery has not yet been established. For quantitative evaluation, this study focused on brain computed tomography perfusion (CTP), which has been recommended by several guidelines of acute ischaemic stroke.

Methods: In the last 2 years, 147 patients hospitalized due to acute type A aortic dissection were retrospectively reviewed. Among the 23 (16%) patients with cerebral malperfusion, 14 who underwent brain CTP (6 preoperative and 8 postoperative) were enrolled. CTP parameters, including regional blood flow and time to maximum, were automatically computed using RApid processing of Perfusion and Diffusion software. The median duration from the onset to hospital arrival was 129 (31-659) min.

Results: Among the 6 patients who underwent preoperative CTP, 4 with salvageable ischaemic lesion (penumbra: 8-735 ml) without massive irreversible ischaemic lesion (ischaemic core: 0-31 ml) achieved acceptable neurological outcomes after emergency aortic replacement regardless of preoperative neurological severity. In contrast, 2 patients with an ischaemic core of >50 ml (73, 51 ml) fell into a vegetative state or neurological death due to intracranial haemorrhage. CTP parameters guided postoperative blood pressure augmentation without additional supra-aortic vessel intervention in the 8 patients who underwent postoperative CTP, among whom 6 achieved normal neurological function regardless of common carotid true lumen stenosis severity.

Conclusions: CTP was able to detect irreversible ischaemic core, guide critical decisions in preoperative patients and aid in determining the blood pressure augmentation for postoperative management focusing on residual brain ischaemia.

目的:急性A型主动脉夹层并灌注不良综合征的治疗仍然具有挑战性。评价术前情况、症状可主观、客观评价脑动脉尚未建立。为了定量评估,本研究重点关注脑计算机断层扫描灌注(CTP),这已被一些急性缺血性卒中指南推荐。方法:回顾性分析我院近2年来收治的急性A型主动脉夹层患者147例。在23例(16%)脑灌注不良患者中,14例行脑CTP(术前6例,术后8例)。CTP参数包括区域血流量和到达最大时间,使用RApid processing of Perfusion and Diffusion软件自动计算。从发病到到达医院的中位时间为129(31-659)分钟。结果:在6例术前接受CTP的患者中,4例有可修复的缺血性病变(半暗区:8-735 ml),无大量不可逆的缺血性病变(缺血核心:0-31 ml),无论术前神经系统严重程度如何,急诊主动脉置换术后神经系统预后均可接受。相比之下,2例缺血性核心>50 ml (73,51 ml)患者因颅内出血而进入植物人状态或神经性死亡。8例术后行CTP的患者,无额外的主动脉上血管干预,CTP参数指导术后血压升高,无论颈总动脉真腔狭窄严重程度如何,其中6例神经功能正常。结论:CTP能够检测不可逆的缺血核心,指导术前患者的关键决策,并有助于确定以残余脑缺血为重点的术后血压升高管理。
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引用次数: 1
Corrigendum to: Contemporary outcomes of cardiac surgery patients supported by the intra-aortic balloon pump. 主动脉内球囊泵支持心脏手术患者的当代结果的更正。
4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2022-06-15 DOI: 10.1093/icvts/ivac136
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引用次数: 0
Normothermic blood polarizing versus depolarizing cardioplegia in a porcine model of cardiopulmonary bypass. 猪体外循环模型中的正常血液极化与去极化心脏停搏液。
4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2022-06-15 DOI: 10.1093/icvts/ivac152
Anne-Margarethe Kramer, Attila Kiss, Stefan Heber, David J Chambers, Seth Hallström, Patrick M Pilz, Bruno K Podesser, David Santer

Objectives: We have previously demonstrated beneficial cardiac protection with hypothermic polarizing cardioplegia compared to a hyperkalemic depolarizing cardioplegia. In this study, a porcine model of cardiopulmonary bypass was used to compare the protective effects of normothermic blood-based polarizing and depolarizing cardioplegia during cardiac arrest.

Methods: Thirteen pigs were randomized to receive either normothermic polarizing (n = 8) or depolarizing (n = 5) blood-based cardioplegia. After initiation of cardiopulmonary bypass, normothermic arrest (34°C, 60 min) was followed by 60 min of on-pump and 90 min of off-pump reperfusion. Primary outcome was myocardial injury measured as arterial myocardial creatine kinase concentration. Secondary outcome was haemodynamic function and the energy state of the hearts.

Results: During reperfusion, release of myocardial creatine kinase was comparable between groups (P = 0.36). In addition, most haemodynamic parameters showed comparable results between groups, but stroke volume (P = 0.03) was significantly lower in the polarizing group. Adenosine triphosphate levels were significantly (18.41 ± 3.86 vs 22.97 ± 2.73 nmol/mg; P = 0.03) lower in polarizing hearts, and the requirement for noradrenaline administration (P = 0.002) and temporary pacing (6 vs 0; P = 0.02) during reperfusion were significantly higher in polarizing hearts.

Conclusions: Under normothermic conditions, polarizing blood cardioplegia was associated with similar myocardial injury to depolarizing blood cardioplegia. Reduced haemodynamic and metabolic outcome and a higher need for temporary pacing with polarized arrest may be associated with the blood-based dilution of this solution.

目的:与高钾去极化心脏停搏液相比,我们之前已经证明了低温极化心脏停跳液对心脏的有益保护作用。在本研究中,使用猪体外循环模型来比较常温血液极化和去极化心脏停搏液在心脏骤停期间的保护作用。方法:13头猪随机接受常温极化(n = 8) 或去极化(n = 5) 基于血液的心脏停搏液。开始体外循环后,常温停搏(34°C,60 分钟)之后是60 泵上的最小值和90 停泵再灌注分钟。主要结果是以动脉心肌肌酸激酶浓度测量的心肌损伤。次要结果是血液动力学功能和心脏的能量状态。结果:再灌注时心肌肌酸激酶的释放在各组间具有可比性(P = 0.36)。此外,大多数血液动力学参数在各组之间显示出可比较的结果,但卒中量(P = 0.03)显著降低。三磷酸腺苷水平显著(18.41 ± 3.86对22.97 ± 2.73 nmol/mg;P = 0.03)和去甲肾上腺素给药要求(P = 0.002)和临时起搏(6 vs 0;P = 0.02)在极化心脏中显著升高。结论:在常温条件下,极化血液心脏停搏液与去极化血液停搏液有相似的心肌损伤。血液动力学和代谢结果的降低以及对极化停搏的临时起搏的更高需求可能与该溶液的基于血液的稀释有关。
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引用次数: 1
Combined mitral valve replacement and coronary artery bypass grafting through a left thoracotomy after retrosternal oesophageal reconstruction 胸骨后食道重建经左开胸联合二尖瓣置换术及冠状动脉旁路移植术
4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2022-06-14 DOI: 10.1093/icvts/ivac161
Ryosuke Numaguchi, C. Shiiku
Abstract A 74-year-old man with a history of retrosternal oesophageal reconstruction was referred for surgical treatment of mitral valve regurgitation and coronary artery disease. He underwent mitral valve replacement combined with coronary artery bypass grafting through a left thoracotomy. Combined mitral valve replacement and coronary artery bypass grafting through a left thoracotomy were feasible in this patient with a retrosternal neo-oesophageal conduit.
摘要一位74岁男性,胸骨后食道重建术,因二尖瓣反流及冠状动脉疾病接受手术治疗。他通过左开胸行二尖瓣置换术联合冠状动脉旁路移植术。经左开胸联合二尖瓣置换术和冠状动脉旁路移植术在胸骨后新食管导管患者中是可行的。
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引用次数: 0
期刊
Interactive cardiovascular and thoracic surgery
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