CORONARY BYPASS OPERATIONS WITH MITRAL VALVE SURGERY

R. MAHMUDOV, A. ABBASELIYEV, S. MUSAYEV, S. KHALILOV, M. YARADANGULIYEVA

Central Hospital of Oilworkers, Baku, AZERBAIJAN

Aim: The aim of this study is to investigate the early and mid-term results of the patients who underwent CABG plus mitral valve surgery in the period of 2007-2011 ys.

Material and methods: 52 patients were included in the study who underwent combined CABG surgery plus restrictive ring annuloplasty, MVR, mitral chordal repair or open commissurotomy.

Results: Within the past 2.5 years in 29 patients were performed CABG surgery plus restrictive ring annuloplasty, in 18 patients were performed CABG surgery plus MVR, in 3 patients were performed CABG surgery plus open commissurotomy and in 2 patients - mitral chordal repair. Restrictive mitral annuloplasty was done in 25 patients with rigid ring of Carpentier-Edwards and in 4 patients with pericardial xenograft. Ring size was 30 mm in 13 cases, 28 mm- 9 cases, 32 mm- 3 cases. Ring annuloplasty decision was made on the basis of visual echocardiography images in the patients who has an enlarged annulus and mitral regurgitation grade II-IV (SPAP = 30-60 mm Hg) without preoperative angina pectoris. Additionally, in 6 patients with restrictive mitral annuloplasty the mitral valves have been approximated by the method of Alfieri. In 8 patients who had degenerative mitral valve disease, restricted motion of leaflets and mitral regurgitation in the echocardiography were performed CABG plus MVR. In 3 patients was performed CABG plus open mitral commissurotomy and in 1 patient with ischemic mitral chordal rupture was performed repair of chorda. 46 patients had a previous infarction and LVEF in this patients was 33.7 ±7.8%. The average number of bypasses was 2.7 ±1.3, duration of the CPB and ACC were 111 ±15.2 and 77 ±11.3 min. In all patients at the weaning from CPB were performed transezofagial echocardiography​​, and was found reduction of mitral regurgitation. Postoperative duration of stay in intensive care unit was 7.8 ± 1.8 days and discharge time was 13.9 ± 2.1 days. Morbidity and revision was not observed. 2 months later in 1 patient was performed MVR due to chordal rupture. Mortality was in 1 patients (1.9 %). All patients ambulatory management continued under the supervision of cardiologist.

Conclusion: We think that the intraoperative transezofagial echocardiography may increase the opportunities of the surgeon in CABG surgery associated with correction of mitral valve pathologies.

TOTAL CORRECTION OF TETRALOGY OF FALLOT: 158 CASES

R. MAHMUDOV, S. MUSAYEV, F. HUSEYNOV, N. MIRZAYEV, E. MAZZA

Central Hospital of Oilworkers, Baku, AZERBAIJAN

Introduction: Tetralogy of Fallot is one of the two most congenital cardiac pathologies. The aim of this study is to present the results of 158 patients who underwent total correction of tetralogy of Fallot in our surgical department in the years between 2006-2011.

Material and methods: The ages of the patients included to the study were between 2-35. To elderly patients with high hemoglobin, hemotocrit and İNR levels was made 1000-1500 cc blood exfusion and plasma or colloid fluids were given. İn the intraoperative or postoperative period was made an autotransfusion of blood that was taken from patients. The Mc Goon index was 1.6-1.8 in 5 patients, 1.8-2.0 in 16 patients and above 2.0 in 137 patients. 128 patients were operated for the first time and 30 patients have been underwent BT shunt operation previously. İn all surgery (aorta - three caval cannulation was performed in 4 patients with persistent left superior vena cava) aorto-bicaval cannulation was performed. İn all cases VSD was closed with xeno-pericardial patch (in 129 patients from left atrium and from infindibulotomy incision in 29 patients). Pericardial ksenograft was used as a transannular patch. Ao/RV ratio was under 0.6 in 75 cases, 0.6-0.8 in 63 cases and 0.8-1.0 in 20 cases. In 152 patients with pressure gradient between RV and pulmonary artery below 40 mmHg was not done any reintervention. In 6 cases with high gradient, RVOT has been expanded again by placing "patch" on the "patch". Average CPB time was 50.3±9.7 min and duration of the ACC was 40.2±8.1 min.

Results: Additional anomalies: ASD-28, PFO-93, persistent left SVC-3, dekstracardia -2, PDA-16, coronary anomaly -2. Mortality was 3 (1.8%). 1 patient with right ventricular muscle band, the residual RVOT stenosis and right ventricular failure was reoperated in 7 days. The sternum was reopened in 3 patients with heart failure and closed in 4-5 days in the intensive care unit. Postoperative echocardiography showed hemodynamically insignificant residual VSD in 8 patients and residual pulmonary gradient in 9 patients. There was not any revision due to complete AV block or bleeding.

Conclusion: We think that there may be better results in congenital cardiovascular surgery when congenital cardiology, surgery, anesthesia and intensive care specialists work together as a team.

Date: 2014-12-28; view: 830