To examine the midterm clinical outcome of pulmonary valve replacement (PVR) with prosthetic valves.
We reviewed 37 consecutive patients who underwent PVR with biological prosthetic valves between ...September 1999 and June 2010. The median age was 22.6 years (range: 6 to 70 years; three children). The primary diagnosis was Tetralogy of Fallot in 20 patients (54%). Valve pathology was regurgitation in 27 patients (72.9%). Cardiac surgery had been previously performed in 35 patients (94.5%). The median size of the prosthesis was 25 mm (range: 21 to 31 mm). The median follow-up was 42 months (range: 1.2 to 129 months).
There were no early valve-related deaths. Hospital mortality was 2.7% (n = 1) and no patient required early rereplacement of prosthesis. Two patients required permanent pacemaker insertion. During follow-up, there was no late death, reoperation for structural valve degeneration, or valve thrombosis. Only one patient required repeated operation for endocarditis at 37 months follow-up. The actuarial survival at 5 years was 95.1 ± 3.8%. Overall freedom from reoperation after PVR at 5 years was 93.0 ± 8.6%. At last follow-up, 34 patients (91.8%) were NYHA class I versus 20 patients (54%) preoperatively (p < 0.05). In the 35 surviving patients who did not undergo redo-PVR, there was no-mild regurgitation and the peak PV gradient was 20.4 ± 10.2 mm Hg (16.2 ± 9.3 mm Hg preoperatively). Thirty-two patients (91.4%) had good right ventricular function compared with 26 patients (74.2%) preoperatively.
PVR with biological prosthetic valves can be performed with good midterm survival, functional status, and haemodynamics.
Pancreaticoduodenectomy is the standard treatment for localised neoplasms of the pancreatic head. The operation can be performed safely in specialist units but good outcome is compromised if ...postoperative blood flow to the liver and biliary tree is inadequate. Coeliac artery occlusion with blood supply to the liver arising from the superior mesenteric artery via the gastroduodenal artery is difficult to recognise, especially intraoperatively. Recognition of absent hepatic artery pulsation after occlusion of the gastroduodenal artery opens a dilemma: should the resection be abandoned or should vascular reconstruction be undertaken, adding risk to an already complex procedure? We describe two cases with a resectable pancreatic endocrine tumour in which coeliac artery occlusion caused by median arcuate ligament compression was identified from cross-sectional imaging and reconstructions. We highlight two different strategies to correct the vascular insufficiency and allow safe pancreatic resection.
Whipple's disease is a chronic condition that is characterized by diarrhea, weight loss and arthropathy, and caused by infection with the fastidious bacterium Tropheryma whipplei. Although once rare, ...Whipple's disease is being increasingly described owing mainly to advances in molecular genetics and an improved isolation of the organism. Whilst cardiac Whipple's disease occurs less commonly, especially in the absence of gastrointestinal symptoms, it has become apparent that some cases of culture-negative endocarditis may well be attributable to T. whipplei. The case is reported of a patient with Whipple's disease endocarditis in association with psoriatic arthritis and lumbar discitis.
Outcome reporting in bariatric surgery needs a core outcome set (COS), an agreed minimum set of outcomes reported in all studies of a particular condition. The aim of this study was to summarize ...outcome reporting in bariatric surgery to inform the development of a COS. Outcomes reported in randomized controlled trials (RCTs) and large non‐randomized studies identified by a systematic review were listed verbatim and categorized into domains, scrutinizing the frequency of outcome reporting and uniformity of definitions. Ninety studies (39 RCTs) identified 1,088 separate outcomes, grouped into nine domains with most (n = 920, 85%) reported only once. The largest outcome domain was ‘surgical complications’, and overall, 42% of outcomes corresponded to a theme of ‘adverse events’. Only a quarter of outcomes were defined, and where provided definitions, which were often contradictory. Percentage of excess weight loss was the main study outcome in 49 studies, but nearly 40% of weight loss outcomes were heterogeneous, thus not comparable. Outcomes of diverse bariatric operations focus largely on adverse events. Reporting is inconsistent and ill‐defined, limiting interpretation and comparison of published studies. Thus, we propose and are developing a COS for the surgical treatment of severe and complex obesity.
Wessex Cardiothoracic Centre, Southampton University Hospitals NHS Trust, Southampton, UK
*Corresponding author. Wessex Cardiothoracic Centre, Southampton General Hospital, Tremona Road, Southampton, ...Hampshire, SO16 6YD, UK. Tel.: +44 2380 777222. E-mail address : sunil.ohri{at}suht.swest.nhs.uk (S.K. Ohri).
We set to examine the mid-term outcome after aortic valve replacement (AVR) with Soprano pericardial stented bioprosthesis measuring 20 mm. Sixty-eight patients underwent AVR between June 2003 and January 2006 (50 women; median age 77 years; range 60–89 years). Preoperatively, 60 patients (88.2%) were in New York Heart Association (NYHA) class III/IV. The mean EuroSCORE was 6.7±2.3. Supra-annular aortoplasty was performed in 21 patients (30.9%), out of which 11 patients received an 18 mm prosthesis (55%). The median follow-up was 45.5 months (0.1–62 months). The 30-day mortality was 4.4% ( n =3) with no early valve-related deaths. No patient suffered a cerebrovascular accident and no patient required replacement of prosthesis for coronary malperfusion. Postoperatively, the mean gradient across the 18 mm bioprosthesis ( n =20) was 25±8.9 mmHg and across the 20 mm bioprosthesis ( n =48) was 25.5±7.3 mmHg ( P =NS). During follow-up, there was no valve-related death, re-operation for structural valve degeneration, endocarditis or valve thrombosis. There were five late deaths and actuarial survival at three and five years was 92.7±3.1% and 81.0±6.9%, respectively. At last follow-up, 86.7% ( n =52) of survivors were in NYHA class I/II. AVR with Soprano bioprosthesis measuring 20 mm is associated with excellent mid-term outcome. Continued follow-up is required to determine the long-term efficacy of the prosthesis.
Key Words: Aortic valve; Soprano; Aortoplasty
Related Article
eComment: Re: Mid-term evaluation of Sorin Soprano bioprostheses in patients with a small aortic annulus 20 mm
Leo A. Bockeria, Ivan I. Scopin, and Alexander A. Makushin
Interactive CardioVascular and Thoracic Surgery 2010 10: 402.
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The role of laparoscopy in two-stage hepatectomy for bilobar colorectal liver metastases (CRLMs) has not yet been extensively investigated.
We reviewed a prospectively collected database of 302 ...consecutive patients undergoing laparoscopic liver resection at our institution between 2003 and 2011.
Eight patients undergoing laparoscopic first/second-stage hepatectomy for bilobar CRLMs (male/female 6:2; median age, 64 years) were analyzed. The first stage consisted of laparoscopic clearance of the left lobe in all patients with no postoperative morbidity and mortality. Seven patients underwent portal vein embolization or ligation. The median interval between first- and second-stage hepatic resections was 89 days (range, 36-123 days). Second-stage hepatectomy with right lobar clearance (open, n=5; laparoscopic, n=2; laparoscopic to open, n=1) was associated with no mortality and an operative morbidity rate of 50%. Adhesions were judged to be minimal or absent during the second-stage procedure. Complications included intra-abdominal collection (n=2), bleeding requiring re-operation (n=1), and bile leak (n=1). R0 resection was obtained in 7 of 8 cases after first-stage resection and in 8 of 8 cases after second-stage resection. Three patients (38%) died from disease recurrence. Of the remaining 5 patients, 4 are disease-free at a median follow-up of 24 months (range, 9-27 months).
The well-recognized advantages of laparoscopy may play a favorable role in the management of patients with bilobar CRLMs candidate for a two-stage resection. The first-stage laparoscopic clearance of the left lobe could progressively become the "gold standard." Laparoscopic second-stage hepatectomy should be limited to selected cases.
Screening is an important strategy for reducing cancer-related mortality in developed countries. Programmes for breast and cervical cancer screening are well established, while protocols for ...prostate, colorectal and ovarian cancer are still being developed 1–7. Population screening programmes help to detect both invasive cancers and pre-malignant disease. Prompt treatment of those identified with cancer can reduce mortality, although screening trials do not consistently improve survival 8–12. Diagnosing cancer early may mean that less invasive treatments with better clinical outcomes can be offered to patients 13, 14.
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