Search

Background. The effect of valve surgical procedures on cognition was investigated in patients undergoing conventional or robotically assisted techniques. The confounding factors of surgical procedure, mood state, preexisting cognitive impairment, and repeated experience with cognitive tests were controlled for. Methods. Patients undergoing conventional valve procedures (n = 15), robotically assisted valve procedures (n = 15), and thoracic surgical procedures (n = 15), along with a nonsurgical control group (n = 15) were tested preoperatively, 1 week after operation, and 8 weeks after operation by use of a battery of cognitive tests and a mood state assessment. Surgical group data were normalized against data from the nonsurgical control group before statistical analysis. Results. Patients undergoing conventional valve procedures performed worse than those undergoing robotically assisted valve procedures on every subtest before operation, and this disadvantage persisted after operation. Age and premorbid intelligence quotient were significantly associated with performance on several cognitive subtests. Anxiety, depression, and stress were not associated with impaired cognitive performance in the surgical groups after operation. A week after operation, patients undergoing conventional valve procedures performed worse on the cognitive tests that had a motor component, which may reflect discomfort caused by the sternotomy. Patients undergoing robotically assisted valve procedures were significantly less impaired on information processing tasks 1 week after operation when compared with those undergoing conventional valve procedures. The majority of patients who were impaired 1 week after operation recovered to preoperation levels within 8 weeks. Conclusions. The robotically assisted valve surgical procedure results in more rapid recovery of performance on cognitive tests. However, regardless of the type of surgical intervention, the prospect of a recovery of cognitive performance to preoperative levels is high. [ABSTRACT FROM AUTHOR]

Extra-aortic counterpulsation for the management of chronic heart failure is a novel approach. We report the use of an extra-aortic implantable counterpulsation pump in the management of a 73-year-old patient with severe heart failure refractory to medical therapy. The implantable counterpulsation pump prolonged his life and greatly improved its quality. The patient lived almost 7 months after the implantation of the device and died of septic complications secondary to gas line infection. [Copyright &y& Elsevier]

Background: Percutaneous mitral valvuloplasty (PMV) is a minimally invasive treatment option for selected patients with mitral stenosis (MS). In general, the procedure is well-tolerated with a high success rate. However, relatively little is known about the predictors of surgical intervention after PMV. Methods: A retrospective analysis was performed on 243 patients undergoing PMV at a single institution over a 14 year period. Results: Fifty (21%) of 243 patients, comprising 44 women and 6 men and aged 55 ± 14 years, underwent cardiac surgery at a median interval of 6 months (range, 0 to 130) after PMV. Nine (18%) underwent a procedure within 15 days, and 41 (82%) had a procedure more than 15 days after the valvuloplasty. After PMV, surgery-free survival was 85% at 1 year, 83% at 2 years, 81% at 3 years, 80% at 4 years, and 80% at 5 years. Conclusions: The need for surgery after PMV is not uncommon. Independent predictors of surgery after PMV included severity of mitral regurgitation (p < 0.003) and a higher echo score (p < 0.039). [Copyright &y& Elsevier]