To report early and long-term outcomes of patients undergoing minimally invasive mitral valve surgery (MIMVS) through right mini-thoracotomy (RT) over a 10-year period.
From September 2003 to ...December 2013, a total of 1604 consecutive patients underwent MIMVS through RT.
The mean age was 63 ± 13 years, 770 (48 %) patients were female and 218 (13.6 %) had previous cardiac operations. The most predominant pathology was degenerative disease (70 %), followed by functional mitral valve regurgitation (12 %), rheumatic disease (9.4 %), endocarditis (5 %) and prosthetic dysfunction (3.2 %). Mitral valve repair was performed in 1137 (71 %) patients and 476 (29 %) had mitral valve replacement. Direct aortic cannulation was achieved in 1325 (83 %) patients. Among patients with degenerative disease candidate for repair (n = 958), rate of mitral valve repair was 95 %. Repair techniques included annuloplasty (95 %), leafleat resection (63 %), neochordae implantation (16 %) and sliding plasty (11 %). Concomitant procedures included tricuspid valve repair (14.6 %), atrial fibrillation ablation (9.5 %) and atrial septal defect closure (3.2 %). Overall in-hospital mortality was 1.1 %. Thirty-four patients (2.1 %) had conversion to sternotomy. Incidence of stroke was 2 %. Overall survival at 10 years was 88 ± 2 %. Freedom from reoperation at 10 years was 94 ± 2 % for repair and 80 ± 6 % for replacement. Freedom from recurrent mitral regurgitation >3+ at 10 years was 90 ± 3 %.
Minimally invasive mitral valve surgery is a safe and reproducible approach associated with low mortality and morbidity, high rate of mitral valve repair and excellent late results.
Pathological fractures due to metastases Fares, G C; Pisani, P C; Quaini, L ...
Italian journal of orthopaedics and traumatology,
1975, Letnik:
Suppl 1
Journal Article
The authors review the literature and report on the treatment of metastatic pathological fractures, on the basis of their own experience of 51 operations. They review the radiological and ...pathological aspects of the lesions, and the methods of investigation. They stress the need for close collaboration between oncologists, radiologists and orthopedic surgeons, and emphasize the role of surgical treatment in the restoration of function and the relief of pain, by stable synthesis of the affected part. The methods employed are those used in traumatology, together with arthroprosthetic replacement. The importance of ensuring a stable synthesis, for the patients' limited life expectancy, justifies the use of acrylic cement, which often establishes continuity that otherwise would not be attainable. The indications for operation are not related to prolonging life but only to improvement in the quality of remaining life as measured by absence of pain and recovery of function. The results should be assessed primarily from the patient's point of view, the aim being to restore his mode of living before the fracture occurred. This has psychological as well as functional value.
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