No abstract

Several minimally invasive approaches, avoiding median sternotomy, have been described within the last few years for cardiac surgery. Femoral arterial and venous cannulation for extracorporeal perfusion are required for many of these operations. The aim of this report is to assess the long-term outcomes of femoral cannulations in patients who underwent minimally invasive procedures. One hundred and sixty patients underwent operations by the port-access method between January 2002 and October 2006. Cardiopulmonary bypass was established by femoral artery-vein cannulation, and a transthoracic clamp was used for the aortic occlusion. One hundred and twenty-one patients were under follow-up in the outpatient clinic and 85 patients underwent Doppler ultrasonography (US) for femoral arterial and venous stenosis. The mean follow-up was 27.9 months (range 1-57 months). There were three hospital mortalities (1.86%), and five late mortalities in this series. The mean follow-up for the Doppler examination was 20.54 months (range 1-56 months). There were two seromas and three wound complications (2.48%), all of which healed after outpatient treatment. All of the flow patterns of the common femoral arteries (CFA) were triphasic except in three of the patients. Three patients (2.48%) were found to have arterial stenosis. One patient with intermittant claudication underwent percutaneous dilatation and stenting of the CFA. Doppler US detected luminal narrowing in two patients who had been having no symptoms, and they are being followed in the outpatient clinic without any complaints. We found a chronic recanalized thrombotic change in the common femoral vein (CFV) in one patient (0.63%). Our study demonstrates vessel patency and/or stenosis in patients without complaints. In conclusion, femoral artery and vein cannulation for port-access surgery with transthoracic clamping can be performed successfully with excellent results in the mid-term.

Spinal cord ischemia may develop into paraplegia in some cases during operation of the thoracoabdominal aorta. This is attributable to the vulnerability of spinal motor neurons to ischemia. In this study, iloprost was used as an agent to decrease the severity of ischemia and reperfusion injury to the spinal cord motor neurons. Twenty-one rabbits were randomized into three groups of seven animals each: group A (iloprost not administered), group B (25 ng/kg per minute iloprost), and group S (sham-operated). The spinal cord ischemia model was created by a 15-min occlusion of the aorta just caudal to the renal artery with a balloon catheter. Administration of iloprost began 10 min before occlusion of the aorta, and continued thereafter for 60 min. The pre- and postocclusion arterial pressure and heart rate recordings, results of blood gas analyses, and hematocrit and glucose levels were recorded. The spinal cords were removed after 8-h monitoring of neurologic function. Viable and nonviable motor neurons in the anterior horn of the spinal cord were counted under light microscopy. Any significant alteration in hemodynamics, blood gases, and other physiologic parameters could not be detected within the groups. Iloprost had a moderately hypotensive effect. Neurologic function in terms of Johnson scoring was significantly better in the iloprost group (P<0.05). The number of viable cells was higher, whereas the number of nonviable cells was lower in iloprost group, when compared with the control group (P<0.05). Higher numbers of viable motor neurons were consistent with the neurological findings. As a result of this study we concluded that iloprost infused during clamping of the aorta mitigates the spinal cord injury due to ischemia and reperfusion, and has a significant protective effect.

Noncoronary cusp replacement for aortic root remodeling in patients with ascending aortic aneurysm is a technically simple and durable operation. Short- and mid-term results of this method were favorable compared to the Bentall procedure.

We present 3 patients, 2 with recent heart transplants, complicated with invasive pulmonary aspergillosis (IPA), treated successfully with surgical resection. These patients demonstrate the role of surgery in management of IPA, and 2 heart transplant patients are of particular interest as surgical treatment of IPA after solid organ transplantation is seldom reported.