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The results were evaluated of a non-resective technique for mitral valve repair with artificial chordae implantation that allows modification of the length of the chordae as many times as necessary, and avoids inadvertent alteration of chordal length during fixation by using removable clips.After having determined the length of the artificial chordae, a removable clip was tied on the two thread ends to prevent sliding when performing the competence test. The length of the artificial chordae could be modified by opening the clip and closing it elsewhere along the chordae length. When the competence test was satisfactory, the threads were knotted on the clips. Long-term follow up was completed between January and May 2012, by echocardiography plus consultation with a cardiologist at the authors' institution.A total of 47 patients underwent repair with this technique. Follow up was complete at a median of 6.0 years. There were no in-hospital deaths, but four deaths occurred during the follow up period (8.5%). The survival rate at six years was 91.5 +/- 2.1%. One patient (2.1%) had recurrent mitral regurgitation (MR) and required reoperation within two years after the initial surgery. The event-free survival rate, defined as survival free from death, reoperation or cardiovascular adverse events, was 87.2 +/- 5.2% at six years. At the time of follow up, echocardiography identified a fully competent valve or minimal MR in 45 patients (96%), mild MR in one patient (2.1%), and significant MR in one patient (2.1%).A satisfactory six-year outcome is reported for this method, whereby removable clips were used to determine the correct length of the artificial chordae, and for accurate tying of the knots.

Background The choice of myocardial revascularization strategy for the right coronary artery (RCA) in patients with multivessel disease and chronic stable angina remains controversial. Our aim was to determine the better strategy—hybrid, combining bypass of the left coronary network and percutaneous coronary intervention of the RCA, or exclusively surgical—and if the latter, the best conduit. Methods We used decision analysis, a modeling technique, to compare two RCA revascularization strategies: surgical grafting and percutaneous coronary intervention. A review of the English language literature determined the variables for each strategy. All possible outcomes of each strategy were analyzed to determine the baseline strategy yielding the highest expected effectiveness. Sensitivity analysis determined the most relevant elements in the model and indicated threshold values. Results Arterial grafting of the RCA led to the highest expected effectiveness, respectively 6% and 7% higher than that of percutaneous coronary intervention and the saphenous graft procedure. Of the arteries available—the radial, right gastroepiploic, and right internal thoracic artery—the most effective was the right internal thoracic artery, pedicled for the proximal part of the RCA and free connected as a Y or a T to the pedicled left internal thoracic artery for the distal part of the RCA. Sensitivity analysis showed surgery to be the appropriate strategy when the expected 1-year patency rate of the arterial graft exceeded 80%. Conclusions This analysis shows arterial grafting of the RCA to have better outcomes than percutaneous coronary intervention, and the right internal thoracic artery to be the best conduit.

The loss of cyclooxygenase in platelets, which lack the capacity for new protein synthesis, constitutes a loss of function for the remainder of their lifetime. The average life span of platelets is 7 days; therefore the conventional practice is to stop aspirin therapy 1 week before the planned procedure. However, the results of this study show that inhibition of platelet aggregation with aspirin vanishes earlier than expected. The life span of the platelet and platelet aggregation as a whole need to be understood separately. Although it may take 10 days for the total platelet population to be renewed and thus restore normal cyclooxygenase activity, it has been shown in vitro that if as few as 20% of total platelets have normal cyclooxygenase activity, aggregation would remain normal. Our study has confirmed this finding in the clinical situation. This study has several limitations. One of these is the small study population. We therefore should extend this study and investigate the outcomes. Another limitation concerns aspirin dosages, which were low (81 mg/d) in this study. If the aspirin dosage had been higher, the speed of recovery of aggregation might have been different. In conclusion, this study indicates that inhibition of platelet

We report three cases of contained rupture of the descending thoracic aorta managed by endovascular stent grafting and discuss the possibility of managing this life-threatening complication in emergency, by endoluminal devices. Further experience is needed to specify the indications for aortic stenting in descendant thoracic aortic ruptures.

Cardiac failure (CHF), renal disease and anemia are interconnected in the CardioRenal Anemia syndrome. Diabetes mellitus remains the most common cause of endstage renal disease (ESRD) in the developed world and when it is associated with these three conditions it worsens the outcomes of these patients. Aim: to evaluate renal anemia and cardiac dysfunction in patients with chronic kidney disease with and without diabetes mellitus (DM). Materials and methods – we assessed 100 patients (40 women and 60 men), 41 patients with DM and 59 patients without DM. All patients had Chronic Kidney Disease (CKD) estimated glomerular filtration rate (eGFR) under 60 ml/min/1,73 mp. We considered anemia when the value of haemoglobin (Hb) was under 11 g/dl. Results – Mean age of the studied patients was 60.38±11.79 years old in women and 59.28±13.89 years old in men. The prevalence of anemia was high in diabetic and non-diabetic patients, too. Anemia was more severe in patients with cardiac dysfunction than in those with normal cardiac function. The higher prevalence of cardiac dysfunction was in patients which had both anemia and DM. There were no significant differences about prevalence of diastolic or systolic cardiac dysfunction in non-diabetic versus diabetic patients. Conclusions – Anemia was an independent predictor for the development of cardiac dysfunction in patients with CKD and the prevalence of cardiac dysfunction was higher in patients who had both anemia and DM than in those without anemia and DM. key words: diabetes mellitus, chronic kidney disease, cardiac dysfunction, heart failure, anemia.

Endoluminal stent graft repair is an alternative to conventional surgical intervention. Perioperative complications associated with the endoluminal technique are arterial injury, maldeployment, aortic perforation, left upper limb ischemia, and paraplegia. Secondary complications are leaking, graft migration, aortoesophageal fistula, and aortobronchial fistula.1 There are various conditions associated with aortoesophageal fistula: foreign bodies, malignancy, primary fistula of thoracic aortic aneurysm, or secondary fistula after surgical repair of these aneurysms.2 We report 2 cases of an uncommon condition: aortoesophageal fistula after stenting of a descending thoracic aneurysm and of a spontaneous aortic rupture with a periaortic hematoma.

Background The aim of this prospective study, based on the completion of the short form health survey questionnaire (SF36) before and 1-year after open heart surgery, was threefold: to evaluate the changes in quality of life (QOL) after open heart surgery, to determine the factors influencing QOL, and to assess the relation between preoperative QOL and 1-year cardiac functional status. Methods Logistic regression was used to determine factors that influence patients' QOL scores and their 1-year cardiac functional status. Different groups were constituted in terms of 1-year cardiac functional status by means of an arborescent classification. Results Comparison of preoperative and postoperative mean scores in the 293 patients included in the study revealed an improvement in all but three dimensions of the SF36 scale. Quality of life improved after operation in an average of 50% of patients. The most frequently found independent predictors of impairment after surgery were NYHA functional class III or IV and angina class III or IV. At 1 year, 64% of patients had satisfactory cardiac functional status. Independent predictive factors of 1-year cardiac functional status were: physical functioning, pain, general health problems, and coronary artery bypass graft. The arborescent classification indicated that the probability of having a "satisfactory" 1-year cardiac functional status was greater than 75% for patients with at least one preoperative QOL dimension above 75 on the scale. Conclusions Preoperative QOL determined by the SF36 is predictive of 1-year cardiac functional status. Coronary artery bypass patients do not recover as well as patients having undergone heart valve surgery.

We present a new pattern for tailoring the "pi" graft that uses the advantages of the mammary loop technique. The two internal thoracic mammary arteries are skeletonized. The free right mammary artery is anastomosed end-to-side to the proximal part of the in situ left mammary artery to make a "Y" graft. The distal end of the left mammary artery is anastomosed end-to-side to the middle portion of the right one to form a loop with the two arteries. The loop is severed at the appropriate level at the time of the coronary anastomosis to form a "pi" graft. This technique allows a more rational use of the length of the two mammary arteries, because the branch leading to the left anterior descending artery is measured and cut precisely at the time of the anastomosis.