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P10-01 Outcomes of secondary interventions after descending aortic aneurysm endovascular repair
Abstracts/International Journal of Cardiology 97 SuppL 2 (2004) S 1 ~ 7 5
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C o n c l u s i o n s : 3DER 2DE was feasible to display vascular rings to define the spatial relations of these vascular anatomy as seen by angiography, and to demonstrate the surgical views for the decision making of the surgical approach. 3DER 2DE can offer a relatively rapid alternative to M R imaging to present the spatial relationships at the bedside or in the cardiac imaging laborato~3J.
third stage operation was performed at age of 18 months with body weight of 10Kg. Extracardiac conduit cavopuhnonary connection with 16mm stretch Gore Tex graft was performed under normothermia, partial cardiopulmonary bypass. The postoperative puhnona~3J pressure was about 15mmHg with 0 2 saturation 95%. After shorbterm follow up for 6 months, the patient has been doing well. Long term result need to be further evaluated.
POSTER SESSION PlO
P10-03
Surgery
OFF-PUMP CORONARY ARTERY BYPASS GRAFTING I N C R E A S E S T H E L E F T V E N T R I C U L A R E J E C T I O N F R A C T I O N IN THE EARLY POSTOPERATIVE PERIOD
P10-01 O U T C O M E S OF S E C O N D A R Y I N T E R V E N T I O N S A F T E R DESCENDING AORTIC ANEURYSM ENDOVASCULAR REPAIR
Yasuaki Fuiisawa, Kiyofumi Morishita, Nobuyoshi Kawaharada, Johji Fukada, ~Patsuya Salto, Tomio Abe. Department of Thoracic and
Cardiovascular Surger; Sapporo Medical University School of Medicine, Sapporo, Japan Objectives: We evaluated tream~ent outcomes in patients who underwent secondary interventions for treatment failure after stent grafting of the descending aorta. M e t h o d s : Between August 2001 and July 2004, 12 patients (63±20 years old) requl~d secondary procedm~s to treat endoleak (n 10) and migration (n 2), with a mean Rrne from initial graft d @ o y m e n t of 8 months. Eight procedures were performed with endovascular stenting through the femoral artery (n 5) or the iliac artery (n 3). Cardiac arrest was induced by adenoNne to avoid occlusion of the head vessels in performing proxinml extension. Surgical secondary operations included three graft replacements. In a dialysis patient, the proximal end of the previously deployed stenbgraft was sutured to the aortic wall to seal proximal endoleak. Results: There was one in hospital death (8%). The patient suffered from retrograde type A aortic dissection during graft replacement of the descending aorta. It is possible that the proxinml clamping caused a tear in the arch of which tissue had become fragile because of the long term d @ o y m e n t of a proximal Z stent. Since that, we have used circulatory arrest for replacing a proximal descending aorta (n 2). Proximal stenbgraft extension was performed in 4 patients and distal extension was performed in 4 patients, with a success rate of 100%. The eleven surviving patients suffered no secondary endoleak over a median follow up period of 10 months. C o n c l u s i o n : Secondary intervention yielded acceptable results. Our experience suggests that proximal clamping in close proximity to a previous deployed stenbgraft should be avoided during secondary graft replacement.
P10-02 STAGE E X T R A C A R D I A C C O N D U I T TOTAL C A V O P U L M O N A R Y CONNECTION FOR HYPOPLASTIC LEFT HEART SYNDROME~A CASE REPORT
Jun Yen Pan 1, Kal Sheng Hsieh 2, Pei Luen Kang 1, Anna L o 1, Tang Ho Wu 1, Bor Yen Lin 1, Kwok Kei Cheng 1. 1Cardiovascular Surgery, 2Pediatrics, Veterans General Hospital-Kaohsiung, ROC This 20 month old boy was a case of hyp@astic left heart syndrome with mitral atresia, subaor tic stenosis, aortic arch hypoplasia, and coarctation of aorta, The first stage operation was performed at age of 6 days with body weight of 2,5Kg, The procedures included patent ductus arteriosus division, resection of coa~etation withend to end anastomosis of aorta, fusion of left common carotid artery and left subclavian artery, and puhnonary arterial banding, The second stage operation was performed at age of 7 months with body weight of 5,7Kg, The procedures included bilateral bidirectional Glenn shunts, atrial septectomy, and Damus Kaye Stansel procedure, The
Yoshihito Irie, Takao Imazeki, Nobuaki Kaki, Ikkoku Hata, HJl-otsugu Yoshida, Shigeyoshi Gon, Mamiko Choh, Kohyu Tanaka,
DoUcyo University School of Medicine, Department of Cardiovascular Surgery, Koshigaya hospital, Koshigaya, Saitama, Japan Objective: Off pump coronary artery bypass grafting (OPCAB) has been suggested to be a minimal invasive surgery, However, the fast recovery from the surgicalintervention was often reported by reducing the inotropic use or the length of intensive care unit and hospital stay, To focus on the left ventricular function, we hypothesized that OPCAB would result in increasing left ventricular ejection fraction (LVEF) g ~ a t e r than the conventional coronary artery bypass grafting (CCABG) in the early postoperative course, Methods: There are 107 patients who received either OPCAB (n 46) or CCABG (n 61) between January 1999 and March 2004. All patients underwent p~operative and postoperative left ventriculography (LVG) for assessment of LVEF by the same method, Results: There were no significant differences in the demographic data between two groups, The interval from operation to postoperative LVG varied from 14 to 17 days, LVEF was significantly increased from pre to post operation in OPCAB group (58,6/+13.1% to 61,3/+13.6%; p 0,039), while there was no significant change in CCABG group (58,6 /+13.1% to 60,2/+12.1%; p 0.1414). C o n c l u s i o n : By avoiding the cardiopulmonary bypass, patients under went OPCAB showed a significant increase of LVEF in early postoperative period can potentially reduce the operative mortality and morbidity,
P10-04 OFF-PUMP CORONARY ARTERY BYPASS TECHNIQUE FOR M U L T I V E S S E L TOTAL A R T E R I A L M Y O C A R D I A L REVASULARIZATION
Hao Ji WeL Shih Rong Hsieh, Hung Wen Tsal, Chung~Chi Wang, Yen Chang. Cardiovascular Division of Surger~ Taichung Veterans
General Hospital, Taichung and College of Medicine, National yang-Ming UniversitN Taipei, Taiwan I n t r o d u c t i o n : The off pump coronary artery bypass (OPCAB) has been prevalent around the world and the benefit of arterial conduits has also been ~ecognized widely. It would seem logical to perfoml total arterial myocardial revascularization with the technique of OPCAB in order to benefit patients the most. Methods: We retrospectively analyzed the results for 136 patients (group 1) who received total arterial myocardial revascula~zation for multivessel diseases with the technique of OPCAB between June 2000 and July 2004 in our institution. The results were compared to the other group of 414 patients (group 2) who ~eceived total arterialrevascularization with cardiopulmonary bypass in the same time period. We use exclusively left internal thoracic artery and radial artery. Composite arterial grafts were realized in three different configurations according to patients' characteristics, coronary anatomy, and target stenosis. Results: 450 male and 100 female were analyzed. The average age is 67.7±9.9 in group 1 and 67.5±9.6. Preoperative risk factor included: DM (27% in group 1 and 31% in group 2), CVA (2.2% in group 1 and 6.2% in
$67
C o n c l u s i o n s : 3DER 2DE was feasible to display vascular rings to define the spatial relations of these vascular anatomy as seen by angiography, and to demonstrate the surgical views for the decision making of the surgical approach. 3DER 2DE can offer a relatively rapid alternative to M R imaging to present the spatial relationships at the bedside or in the cardiac imaging laborato~3J.
third stage operation was performed at age of 18 months with body weight of 10Kg. Extracardiac conduit cavopuhnonary connection with 16mm stretch Gore Tex graft was performed under normothermia, partial cardiopulmonary bypass. The postoperative puhnona~3J pressure was about 15mmHg with 0 2 saturation 95%. After shorbterm follow up for 6 months, the patient has been doing well. Long term result need to be further evaluated.
POSTER SESSION PlO
P10-03
Surgery
OFF-PUMP CORONARY ARTERY BYPASS GRAFTING I N C R E A S E S T H E L E F T V E N T R I C U L A R E J E C T I O N F R A C T I O N IN THE EARLY POSTOPERATIVE PERIOD
P10-01 O U T C O M E S OF S E C O N D A R Y I N T E R V E N T I O N S A F T E R DESCENDING AORTIC ANEURYSM ENDOVASCULAR REPAIR
Yasuaki Fuiisawa, Kiyofumi Morishita, Nobuyoshi Kawaharada, Johji Fukada, ~Patsuya Salto, Tomio Abe. Department of Thoracic and
Cardiovascular Surger; Sapporo Medical University School of Medicine, Sapporo, Japan Objectives: We evaluated tream~ent outcomes in patients who underwent secondary interventions for treatment failure after stent grafting of the descending aorta. M e t h o d s : Between August 2001 and July 2004, 12 patients (63±20 years old) requl~d secondary procedm~s to treat endoleak (n 10) and migration (n 2), with a mean Rrne from initial graft d @ o y m e n t of 8 months. Eight procedures were performed with endovascular stenting through the femoral artery (n 5) or the iliac artery (n 3). Cardiac arrest was induced by adenoNne to avoid occlusion of the head vessels in performing proxinml extension. Surgical secondary operations included three graft replacements. In a dialysis patient, the proximal end of the previously deployed stenbgraft was sutured to the aortic wall to seal proximal endoleak. Results: There was one in hospital death (8%). The patient suffered from retrograde type A aortic dissection during graft replacement of the descending aorta. It is possible that the proxinml clamping caused a tear in the arch of which tissue had become fragile because of the long term d @ o y m e n t of a proximal Z stent. Since that, we have used circulatory arrest for replacing a proximal descending aorta (n 2). Proximal stenbgraft extension was performed in 4 patients and distal extension was performed in 4 patients, with a success rate of 100%. The eleven surviving patients suffered no secondary endoleak over a median follow up period of 10 months. C o n c l u s i o n : Secondary intervention yielded acceptable results. Our experience suggests that proximal clamping in close proximity to a previous deployed stenbgraft should be avoided during secondary graft replacement.
P10-02 STAGE E X T R A C A R D I A C C O N D U I T TOTAL C A V O P U L M O N A R Y CONNECTION FOR HYPOPLASTIC LEFT HEART SYNDROME~A CASE REPORT
Jun Yen Pan 1, Kal Sheng Hsieh 2, Pei Luen Kang 1, Anna L o 1, Tang Ho Wu 1, Bor Yen Lin 1, Kwok Kei Cheng 1. 1Cardiovascular Surgery, 2Pediatrics, Veterans General Hospital-Kaohsiung, ROC This 20 month old boy was a case of hyp@astic left heart syndrome with mitral atresia, subaor tic stenosis, aortic arch hypoplasia, and coarctation of aorta, The first stage operation was performed at age of 6 days with body weight of 2,5Kg, The procedures included patent ductus arteriosus division, resection of coa~etation withend to end anastomosis of aorta, fusion of left common carotid artery and left subclavian artery, and puhnonary arterial banding, The second stage operation was performed at age of 7 months with body weight of 5,7Kg, The procedures included bilateral bidirectional Glenn shunts, atrial septectomy, and Damus Kaye Stansel procedure, The
Yoshihito Irie, Takao Imazeki, Nobuaki Kaki, Ikkoku Hata, HJl-otsugu Yoshida, Shigeyoshi Gon, Mamiko Choh, Kohyu Tanaka,
DoUcyo University School of Medicine, Department of Cardiovascular Surgery, Koshigaya hospital, Koshigaya, Saitama, Japan Objective: Off pump coronary artery bypass grafting (OPCAB) has been suggested to be a minimal invasive surgery, However, the fast recovery from the surgicalintervention was often reported by reducing the inotropic use or the length of intensive care unit and hospital stay, To focus on the left ventricular function, we hypothesized that OPCAB would result in increasing left ventricular ejection fraction (LVEF) g ~ a t e r than the conventional coronary artery bypass grafting (CCABG) in the early postoperative course, Methods: There are 107 patients who received either OPCAB (n 46) or CCABG (n 61) between January 1999 and March 2004. All patients underwent p~operative and postoperative left ventriculography (LVG) for assessment of LVEF by the same method, Results: There were no significant differences in the demographic data between two groups, The interval from operation to postoperative LVG varied from 14 to 17 days, LVEF was significantly increased from pre to post operation in OPCAB group (58,6/+13.1% to 61,3/+13.6%; p 0,039), while there was no significant change in CCABG group (58,6 /+13.1% to 60,2/+12.1%; p 0.1414). C o n c l u s i o n : By avoiding the cardiopulmonary bypass, patients under went OPCAB showed a significant increase of LVEF in early postoperative period can potentially reduce the operative mortality and morbidity,
P10-04 OFF-PUMP CORONARY ARTERY BYPASS TECHNIQUE FOR M U L T I V E S S E L TOTAL A R T E R I A L M Y O C A R D I A L REVASULARIZATION
Hao Ji WeL Shih Rong Hsieh, Hung Wen Tsal, Chung~Chi Wang, Yen Chang. Cardiovascular Division of Surger~ Taichung Veterans
General Hospital, Taichung and College of Medicine, National yang-Ming UniversitN Taipei, Taiwan I n t r o d u c t i o n : The off pump coronary artery bypass (OPCAB) has been prevalent around the world and the benefit of arterial conduits has also been ~ecognized widely. It would seem logical to perfoml total arterial myocardial revascularization with the technique of OPCAB in order to benefit patients the most. Methods: We retrospectively analyzed the results for 136 patients (group 1) who received total arterial myocardial revascula~zation for multivessel diseases with the technique of OPCAB between June 2000 and July 2004 in our institution. The results were compared to the other group of 414 patients (group 2) who ~eceived total arterialrevascularization with cardiopulmonary bypass in the same time period. We use exclusively left internal thoracic artery and radial artery. Composite arterial grafts were realized in three different configurations according to patients' characteristics, coronary anatomy, and target stenosis. Results: 450 male and 100 female were analyzed. The average age is 67.7±9.9 in group 1 and 67.5±9.6. Preoperative risk factor included: DM (27% in group 1 and 31% in group 2), CVA (2.2% in group 1 and 6.2% in