011). Cerebral oxygen extraction at antegrade cerebral perfusion rates of 30 and 50 mL/kg/min was equal to baseline (P = .53,.48) but greater than baseline (P < .0001) at an antegrade cerebral perfusion rate of 10 mL/kg/min. The distributions of cerebral blood flow and regional oxygen saturation were equal in each brain hemisphere at all antegrade cerebral perfusion rates.
Conclusion: Cerebral blood flow increased with this website antegrade cerebral perfusion rate. At an antegrade cerebral perfusion rate of 50 mL/kg/min, cerebral
blood flow was equal to baseline, but regional oxygen saturation and cerebral oxygen extraction trends suggested more oxygenation than baseline. An antegrade cerebral perfusion rate of 30 mL/kg/min provided only 60% of baseline cerebral blood flow, but cerebral oxygen extraction and regional oxygen saturation were equal to baseline. An antegrade cerebral
perfusion rate that closely matches standard cardiopulmonary bypass conditions is between 30 and 50 mL/kg/min. (J Thorac Cardiovasc Surg 2010;139:530-5)”
“Objectives: Autograft dilatation is leading to an increase in root reoperations late after the Ross procedure. A 14-year clinical experience was reviewed to define the feasibility and outcome of the autograft valve-sparing root reoperation.
Methods: One hundred twenty-six patients surviving an average of 7.4 +/- 9.9 years after the Ross procedure underwent cross-sectional clinical and echocardiographic examination. Study end points were freedom from autograft dilatation (diameter>4 cm or 2.1 cm/m(2)), root reoperation, root replacement, and functional outcome Selleckchem AZD9291 after the valve-sparing reoperation.
Results: Thirty-one (25%) patients had dilatation, with 45% +/- 9% freedom at 14 years. In 14 (11%) patients an autograft aneurysm (>5.0 cm) was found: 12 had reoperations at 8.9 +/- 2.6 years after
the Ross procedure. Risk factors for root reoperation at multivariate analysis were root technique (P-.01), root dilatation (P-.001), and follow-up duration (P=.06). Two patients had root replacement, and 10 (83%) had remodeling with valve preservation (8 Yacoub procedures and 2 sinotubular junction/ascending aorta procedures); all survived reoperation. Absence of severe selleck screening library autograft insufficiency (P=.04) and convergent-type aneurysm (P=.05) were associated with successful valve preservation. Fourteen-year freedom from root reoperation was 80% +/- 7%, and freedom from full root replacement was 97% +/- 4%. At 3.2 +/- 1.5 years (range, 0.2-4.8 years) after root reoperation, all patients are in New York Heart Association class I and are medication free: 9 of 10 patients have mild autograft valve insufficiency or less, and 1 required valve replacement 51 months after remodeling. One patient carried out 2 uncomplicated pregnancies 3 and 4 years after the Ross-Yacoub procedure.