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Doig F, Finucane K, Skillington P, Jones S, Sharma V, Daley M, Wall D, Suna J, Alphonso N, Bandara D, Chard R, Calderoni F, Brizard C. Surgical Management of Ebstein Anomaly: The Australia and New Zealand Experience. World J Pediatr Congenit Heart Surg 2024; 15:155-159. [PMID: 38263637 DOI: 10.1177/21501351231189279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
BACKGROUND Ebstein anomaly is a rare congenital anomaly of the tricuspid valve which presents challenges to cardiac surgeons due to the spectrum of the disease and the technical difficulty of valve repair. The natural history of the anomaly differs between patients presenting in the neonatal period to those presenting in adulthood. METHODS A retrospective review of all patients >15 years of age with Ebstein anomaly, undergoing surgery on the tricuspid valve at 6 centers across Australia and New Zealand was performed. Patients from 1985 to 2019 were included in the study. RESULTS A total of 125 patients were included in the study, 76 patients (60%) undergoing tricuspid valve repair, of which 23 patients underwent a Cone repair and 49 (40%) had a tricuspid valve replacement. The mean follow-up was 7.9 ± 7.3 years. Postoperatively, early mortality was 3 patients (2%) and 10-year survival was 91.5%. A postoperative pacemaker was required in 24 patients (19%). Reoperation was required in 21 patients (17%). There was no statistically significant difference in survival or reoperation between patients who underwent repair or replacement of the tricuspid valve; however, with a small number of patients in long-term follow-up. CONCLUSION Older children and adult patients undergoing surgery for Ebstein anomaly in Australia and New Zealand experience good medium-term postoperative survival. Repair of the valve is achieved in a significant proportion of patients with increasing use and success with the Cone repair technique.
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Affiliation(s)
- F Doig
- Department of Paediatric and Congenital Cardiac Services, Starship Hospital, Auckland, New Zealand
| | - K Finucane
- Department of Paediatric and Congenital Cardiac Services, Starship Hospital, Auckland, New Zealand
| | - P Skillington
- Department of Cardiothoracic Surgery, Royal Melbourne Hospital, Melbourne, Australia
| | - S Jones
- Department of Cardiothoracic Surgery, The Prince Charles Hospital, Brisbane, Australia
| | - V Sharma
- Department of Cardiothoracic Surgery, The Prince Charles Hospital, Brisbane, Australia
| | - M Daley
- Department of Cardiothoracic Surgery, The Prince Charles Hospital, Brisbane, Australia
| | - D Wall
- Department of Cardiothoracic Surgery, The Prince Charles Hospital, Brisbane, Australia
| | - J Suna
- Queensland Paediatric Cardiac Service, Queensland Children's Hospital, Brisbane, Australia
| | - N Alphonso
- Queensland Paediatric Cardiac Service, Queensland Children's Hospital, Brisbane, Australia
| | - D Bandara
- Department of Cardiothoracic Surgery, Westmead Hospital, Sydney, Australia
| | - R Chard
- Department of Cardiothoracic Surgery, Westmead Hospital, Sydney, Australia
| | - F Calderoni
- Cardiac Surgery Unit, Royal Children's Hospital, Melbourne, Australia
| | - C Brizard
- Cardiac Surgery Unit, Royal Children's Hospital, Melbourne, Australia
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Konstantinov IE, Bacha E, Barron D, David T, Dearani J, d'Udekem Y, El-Hamamsy I, Najm HK, Del Nido PJ, Pizarro C, Skillington P, Starnes VA, Winlaw D. Optimal timing of Ross operation in children: A moving target? J Thorac Cardiovasc Surg 2024:S0022-5223(24)00175-2. [PMID: 38350595 DOI: 10.1016/j.jtcvs.2024.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 12/30/2023] [Accepted: 02/05/2024] [Indexed: 02/15/2024]
Affiliation(s)
- Igor E Konstantinov
- Royal Children's Hospital, University of Melbourne, Murdoch Children's Research Institute, Melbourne Centre for Cardiovascular Genomics and Regenerative Medicine, Melbourne, Australia.
| | - Emile Bacha
- Columbia University Medical Center, Morgan Stanley Children's Hospital, New York, NY
| | - David Barron
- Department of Cardiovascular Surgery, Hospital for Sick Children, Toronto, Canada
| | - Tirone David
- Department of Cardiovascular Surgery, Toronto General Hospital, Toronto, Canada
| | - Joseph Dearani
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn
| | - Yves d'Udekem
- Division of Cardiac Surgery, Children's National Heart Institute, The George Washington University School of Medicine and Health Sciences, Children's National Hospital, Washington, DC
| | | | - Hani K Najm
- Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | | | - Christian Pizarro
- Cardiothoracic Surgery, Thomas Jefferson University, Nemours Cardiac Center, Wilmington, Del
| | - Peter Skillington
- Department of Cardiothoracic Surgery, Royal Melbourne Hospital, Melbourne, Australia
| | - Vaughn A Starnes
- Department of Surgery, Keck School of Medicine, University of South California, Los Angeles, Calif
| | - David Winlaw
- Department of Cardiothoracic Surgery, Heart Center, Ann and Robert H. Lurie Children's Hospital, Northwestern University, Chicago, Ill
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3
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Jolliffe J, Moten S, Tripathy A, Skillington P, Tatoulis J, Muneretto C, Di Bacco L, Galvao HBF, Goldblatt J. Perceval valve intermediate outcomes: a systematic review and meta-analysis at 5-year follow-up. J Cardiothorac Surg 2023; 18:129. [PMID: 37041628 PMCID: PMC10091543 DOI: 10.1186/s13019-023-02273-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 04/04/2023] [Indexed: 04/13/2023] Open
Abstract
OBJECTIVES New technologies for the treatment of Aortic Stenosis are evolving to minimize risk and treat an increasingly comorbid population. The Sutureless Perceval Valve is one such alternative. Whilst short-term data is promising, limited mid-term outcomes exist, until now. This is the first systematic review and meta-analysis to evaluate mid-term outcomes in the Perceval Valve in isolation. METHODS A systematic literature review of 5 databases was performed. Articles included evaluated echocardiographic and mortality outcomes beyond 5 years in patients who had undergone Perceval Valve AVR. Two reviewers extracted and reviewed the articles. Weighted estimates were performed for all post-operative and mid-term data. Aggregated Kaplan Meier curves were reconstructed from digitised images to evaluate long-term survival. RESULTS Seven observational studies were identified, with a total number of 3196 patients analysed. 30-day mortality was 2.5%. Aggregated survival at 1, 2, 3, 4 and 5 years was 93.4%, 89.4%, 84.9%, 82% and 79.5% respectively. Permanent pacemaker implantation (7.9%), severe paravalvular leak (1.6%), structural valve deterioration (1.5%), stroke (4.4%), endocarditis (1.6%) and valve explant (2.3%) were acceptable at up to mid-term follow up. Haemodynamics were also acceptable at up mid-term with mean-valve gradient (range 9-13.6 mmHg), peak-valve gradient (17.8-22.3 mmHg) and effective orifice area (1.5-1.8 cm2) across all valve sizes. Cardiopulmonary bypass (78 min) and Aortic cross clamp times (52 min) were also favourable. CONCLUSION To our knowledge, this represents the first meta-analysis to date evaluating mid-term outcomes in the Perceval Valve in isolation and demonstrates good 5-year mortality, haemodynamic and morbidity outcomes. KEY QUESTION What are the mid-term outcomes at up to 5 years follow up in Perceval Valve Aortic Valve Replacement? KEY FINDINGS Perceval Valve AVR achieves 80% freedom from mortality at 5 years with low valve gradients and minimal morbidity. KEY OUTCOMES Perceval Valve Aortic Valve Replacement has acceptable mid-term mortality, durability and haemodynamic outcomes.
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Affiliation(s)
- Jarrod Jolliffe
- Cardiothoracic Department, Royal Melbourne Hospital, 300 Grattan Street Parkville, Melbourne, VIC, Australia.
| | - Simon Moten
- Cardiothoracic Department, Royal Melbourne Hospital, 300 Grattan Street Parkville, Melbourne, VIC, Australia
| | - Amit Tripathy
- Cardiothoracic Department, Royal Melbourne Hospital, 300 Grattan Street Parkville, Melbourne, VIC, Australia
| | - Peter Skillington
- Cardiothoracic Department, Royal Melbourne Hospital, 300 Grattan Street Parkville, Melbourne, VIC, Australia
| | - James Tatoulis
- Cardiothoracic Department, Royal Melbourne Hospital, 300 Grattan Street Parkville, Melbourne, VIC, Australia
| | | | - Lorenzo Di Bacco
- School of Cardiac Surgery, University of Brescia, Brescia, Italy
| | | | - John Goldblatt
- Cardiothoracic Department, Royal Melbourne Hospital, 300 Grattan Street Parkville, Melbourne, VIC, Australia
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4
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Ratnaraj V, Ivanov A, Buratto E, Skillington P. Cardio-Cutaneous Fistulae-Beware the Late Sternal Wound Lesion. Eur J Cardiothorac Surg 2023; 63:7082537. [PMID: 36943355 DOI: 10.1093/ejcts/ezad099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 03/07/2023] [Accepted: 03/16/2023] [Indexed: 03/23/2023] Open
Abstract
Cardio-cutaneous fistula is a very rare complication of cardiac surgery, and the optimal management strategy is unclear. We present a case of a right ventricle-to-pulmonary artery conduit (RV-PA) forming a cutaneous fistulate that was successfully surgically repaired. A 43-year-old male presented for an elective RV-PA conduit replacement with a cutaneous skin lesion and associated sub-sternal collection. The patient underwent redo-sternotomy for the previous surgical replacement RV-PA conduit, of pulmonary atresia, ventricular septal defect, and ligation of main aorto-pulmonary collateral arteries in childhood, with the subsequent upgrade of the RV-PA conduit using pulmonary homograft. Upon entry into the thoracic cavity, it was clear that there was a direct fistula formed from the RV-PA conduit that was responsible for the skin lesion and hence a direct communication to the PA. We discuss the surgical method and surrounding discussions regarding Cardio-cutaneous fistula in a successful surgical repair when the pathology is difficult to truly identify preoperatively.
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Affiliation(s)
- Vignesh Ratnaraj
- Department of Cardiothoracic Surgery, The Royal Melbourne Hospital, 300 Grattan St, Parkville, VIC, 3050
| | - Asen Ivanov
- Department of Cardiothoracic Surgery, The Royal Melbourne Hospital, 300 Grattan St, Parkville, VIC, 3050
| | - Edward Buratto
- Department of Cardiothoracic Surgery, The Royal Melbourne Hospital, 300 Grattan St, Parkville, VIC, 3050
| | - Peter Skillington
- Department of Cardiothoracic Surgery, The Royal Melbourne Hospital, 300 Grattan St, Parkville, VIC, 3050
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5
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Stoica S, Beard C, Takkenberg JJM, Mokhles MM, Turner M, Pepper J, Hopewell-Kelly N, Benedetto U, Nashef SAM, El-Hamamsy I, Skillington P, Glauber M, De Paulis R, Tseng E, Meuris B, Sitges M, Delgado V, Krane M, Kostolny M, Pufulete M. Formal consensus study on surgery to replace the aortic valve in adults aged 18-60 years. Heart 2023; 109:857-865. [PMID: 36849232 DOI: 10.1136/heartjnl-2022-321740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 12/12/2022] [Indexed: 03/01/2023] Open
Abstract
OBJECTIVE There is uncertainty about surgical procedures for adult patients aged 18-60 years undergoing aortic valve replacement (AVR). Options include conventional AVR (mechanical, mAVR; tissue, tAVR), the pulmonary autograft (Ross) and aortic valve neocuspidisation (Ozaki). Transcatheter treatment may be an option for selected patients. We used formal consensus methodology to make recommendations about the suitability of each procedure. METHODS A working group, supported by a patient advisory group, developed a list of clinical scenarios across seven domains (anatomy, presentation, cardiac/non-cardiac comorbidities, concurrent treatments, lifestyle, preferences). A consensus group of 12 clinicians rated the appropriateness of each surgical procedure for each scenario on a 9-point Likert scale on two separate occasions (before and after a 1-day meeting). RESULTS There was a consensus that each procedure was appropriate (A) or inappropriate (I) for all clinical scenarios as follows: mAVR: total 76% (57% A, 19% I); tAVR: total 68% (68% A, 0% I); Ross: total 66% (39% A, 27% I); Ozaki: total 31% (3% A, 28% I). The remainder of percentages to 100% reflects the degree of uncertainty. There was a consensus that transcatheter aortic valve implantation is appropriate for 5 of 68 (7%) of all clinical scenarios (including frailty, prohibitive surgical risk and very limited life span). CONCLUSIONS Evidence-based expert opinion emerging from a formal consensus process indicates that besides conventional AVR options, there is a high degree of certainty about the suitability of the Ross procedure in patients aged 18-60 years. Future clinical guidelines should include the option of the Ross procedure in aortic prosthetic valve selection.
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Affiliation(s)
- Serban Stoica
- Cardiothoracic Surgery, Bristol Heart Institute, Bristol, UK
| | - Chloe Beard
- Cardiothoracic Surgery, Bristol Heart Institute, Bristol, UK
| | | | - Mostafa M Mokhles
- Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Mark Turner
- Department of Cardiology, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - John Pepper
- Surgery, Royal Brompton Hospital, London, UK
| | - Noreen Hopewell-Kelly
- Health and Social Sciences, University of the West of England-Frenchay Campus, Bristol, UK
| | | | - Samer A M Nashef
- Cardiac Surgery, Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | | | | | | | | | - Elaine Tseng
- University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Bart Meuris
- Cardiac Surgery, KU Leuven University Hospitals Leuven, Leuven, Belgium
| | - Marta Sitges
- Cardiology, Hospital Clinic de Barcelona, Barcelona, Spain
| | | | - Markus Krane
- Yale School of Medicine, New Haven, Connecticut, USA
| | - Martin Kostolny
- Cardiothoracic Unit, Great Ormond Street Hospital and Institute of Cardiovascular Science, University College London, London, UK
| | - Maria Pufulete
- Bristol Heart Institute, Bristol Medical School, University of Bristol, Bristol, UK
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Skillington P, Tripathy AK, Keefe MO, Larobina M. Right-sided reconstruction during the Ross procedure—A technical perspective for long-term durability. JTCVS Tech 2021; 10:403-407. [PMID: 34984396 PMCID: PMC8691921 DOI: 10.1016/j.xjtc.2021.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 10/08/2021] [Indexed: 11/19/2022] Open
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7
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Flynn CD, De Bono JH, Muston B, Rattan N, Tian DH, Larobina M, O'Keefe M, Skillington P. Systematic review and meta-analysis of long-term outcomes in adults undergoing the Ross procedure. Ann Cardiothorac Surg 2021; 10:411-419. [PMID: 34422553 DOI: 10.21037/acs-2021-rp-30] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 06/18/2021] [Indexed: 12/15/2022]
Abstract
Background The management of aortic valve disease is becoming increasingly complicated with the evolution of treatment options available to cardiac surgeons and cardiologist. Pulmonary autograft replacement of the aortic valve, commonly known as the Ross procedure, involves excision of the pulmonary valve from the right ventricular outflow tract and implantation in the aortic position. This systematic review aims to evaluate the long-term outcomes, following the Ross procedure. Methods An electronic search strategy queried five online medical referencing databases from inception to 21 August 2020. All studies detailing the long-term outcomes of adults undergoing the Ross procedure were included. A random effects model was used to determine pooled continuous data. Enhanced secondary survival analysis was performed on reconstructed individual patient data. Results Twenty-three studies were included in the qualitative synthesis, including a total of 6,278 patients with a mean follow-up duration of 6.0±2.8 years. Long-term survival was 95.6%, 91.8%, 86.3% and 80.5% at five, ten, fifteen and twenty years, respectively. Freedom from autograft reoperation was 95.7%, 91.2%, 84.9% and 76.1% at five, ten, fifteen and twenty years, respectively. Conclusions When performed in experienced centres and for appropriately selected patients, the Ross procedure represents a durable replacement of the aortic valve with excellent long-term survival.
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Affiliation(s)
- Campbell D Flynn
- Department of Cardiothoracic Surgery, Epworth Hospital, Richmond, Victoria, Australia
| | - Joshua H De Bono
- Department of Cardiothoracic Surgery, Epworth Hospital, Richmond, Victoria, Australia
| | - Benjamin Muston
- Collaborative Research Group, Sydney, Australia.,Faculty of Medicine, University of New South Wales, Sydney, Australia
| | | | - David H Tian
- Department of Anaesthesia and Perioperative Medicine, Westmead Hospital, Sydney, Australia
| | - Marco Larobina
- Department of Cardiothoracic Surgery, Epworth Hospital, Richmond, Victoria, Australia.,University of Melbourne, Melbourne, Victoria, Australia.,Department of Cardiothoracic Surgery and Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Michael O'Keefe
- Department of Cardiothoracic Surgery, Epworth Hospital, Richmond, Victoria, Australia.,Department of Cardiothoracic Surgery and Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Peter Skillington
- Department of Cardiothoracic Surgery, Epworth Hospital, Richmond, Victoria, Australia.,University of Melbourne, Melbourne, Victoria, Australia.,Department of Cardiothoracic Surgery and Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
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8
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Lee MG, Yao JV, Binny S, Larobina M, Skillington P, Grigg LE, Zentner D. Long-term outcome of adult survivors of tetralogy of Fallot. International Journal of Cardiology Congenital Heart Disease 2021. [DOI: 10.1016/j.ijcchd.2021.100147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
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9
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Cheuk N, Worth LJ, Tatoulis J, Skillington P, Kyi M, Fourlanos S. The relationship between diabetes and surgical site infection following coronary artery bypass graft surgery in current-era models of care. J Hosp Infect 2021; 116:47-52. [PMID: 34332004 DOI: 10.1016/j.jhin.2021.07.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 06/28/2021] [Accepted: 07/22/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Although diabetes is a recognized risk factor for postoperative infections, the seminal Portland Diabetic Project studies in cardiac surgery demonstrated intravenous insulin infusions following open-cardiac surgery achieved near normal glycaemia and decreased deep sternal wound infection to similar rates to those without diabetes. AIM We sought to examine a contemporary cohort of patients undergoing coronary artery bypass graft surgery (CABGS) to evaluate the relationship between diabetes, hyperglycaemia and risk of surgical site infection (SSI) in current-era models of care. METHODS Consecutive patients who underwent CABGS between 2016 and 2018 were identified through a state-wide data repository for healthcare-associated infections. Clinical characteristics and records of postoperative SSIs were obtained from individual chart review. Type 2 diabetes (T2D), perioperative glycaemia and other clinical characteristics were analysed in relation to the development of SSI. FINDINGS Of the 953 patients evaluated, 11% developed SSIs a median eight days post CABGS, with few cases of deep SSIs (<1%). T2D was evident in 41% and more prevalent in those who developed SSIs (51%). On multivariate analysis T2D was not significantly associated with development of SSI (odds ratio (OR) 1.35; P=0.174) but body mass index (BMI) remained a significant risk factor (OR 1.07, P<0.001). In patients with T2D, perioperative glycaemia was not significantly associated with SSI. CONCLUSION In a specialist cardiac surgery centre using perioperative intravenous insulin infusions and antibiotic prophylaxis, deep SSIs were uncommon; however, approximately one in 10 patients developed superficial SSIs. T2D was not independently associated with SSI yet BMI was independently associated with SSI post CABGS.
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Affiliation(s)
- N Cheuk
- Department of Diabetes and Endocrinology, Royal Melbourne Hospital, Australia.
| | - L J Worth
- Victorian Healthcare Associated Infection Surveillance System (VICNISS) Coordinating Centre, Doherty Institute, Australia; National Centre for Infections in Cancer, Sir Peter MacCallum Department of Oncology, University of Melbourne, Australia
| | - J Tatoulis
- Department of Cardiothoracic Surgery, Royal Melbourne Hospital, Australia
| | - P Skillington
- Department of Cardiothoracic Surgery, Royal Melbourne Hospital, Australia
| | - M Kyi
- Department of Diabetes and Endocrinology, Royal Melbourne Hospital, Australia; Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Australia
| | - S Fourlanos
- Department of Diabetes and Endocrinology, Royal Melbourne Hospital, Australia; Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Australia
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10
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Thuraisingam A, Skillington P, Ludhani P, Wijayarathne PM, Menahem S, Larobina M, Grigg L, Wilson W. Long-term outcomes of right ventricle-to-pulmonary artery conduit insertion in adults with congenital heart disease: survival analysis by National Death Index. Eur J Cardiothorac Surg 2021; 60:939-946. [PMID: 33779724 DOI: 10.1093/ejcts/ezab148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 02/09/2021] [Accepted: 02/24/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES The aim of this study was to investigate the long-term outcomes following right ventricle-to-pulmonary artery (RV-to-PA) conduit insertion of Medtronic Freestyle® porcine valve (MFV) or pulmonary allograft valve (PAV) in adult patients with congenital heart disease. METHODS Retrospective medical record review of consecutive RV-to-PA conduit insertion, using either PAV or MFV from 1991 to 2017. Perioperative data and clinic reports were collected. Cause and date of death were obtained from the Australian National Death Index to obtain survival function. RESULTS In total, 232 patients (median age 31.5 years, interquartile range 25-41 years) underwent RV-to-PA conduit insertion (PAV = 84 and MFV = 148) and were eligible for inclusion [63.8% tetralogy of Fallot (TOF); 11.6% congenital pulmonary stenosis (PS); 24.6% other diagnoses]. The overall median follow-up time was 9.1 years (interquartile range 5.3-12.6 years). The mean gradient was 11.8 ± 7.1 mmHg in PAV and 16.6 ± 9.6 mmHg in MFV patients. Congenital PS patients had 100% survival at 20 years, TOF patients at 5, 10, 15 and 20 years had 99%, 97%, 96% and 96% survival, respectively. Patients with other primary diagnoses at 5, 10, 15 and 20 years had 93%, 91%, 87% and 87% respectively. Freedom from reintervention did not differ significantly at 5 and 10 years between pulmonary allograft (98.6%, 98.6%) and Freestyle® porcine bioprosthesis (97.5%, 93%). CONCLUSIONS Both valves perform equally well with regard to patients' freedom from reoperation, although transvalvular gradient was higher for Freestyle® patients. Congenital PS and TOF patients had better survival than patients with other primary diagnoses.
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Affiliation(s)
- Amalan Thuraisingam
- Department of Cardiothoracic Surgery, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Peter Skillington
- Department of Cardiothoracic Surgery, Royal Melbourne Hospital, Melbourne, VIC, Australia.,Department of Cardiothoracic Surgery, Melbourne Private Hospital, Parkville, VIC, Australia.,Department of Cardiothoracic Surgery, Epworth Hospital, Richmond, VIC, Australia
| | - Prakash Ludhani
- Department of Cardiothoracic Surgery, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | | | - Samuel Menahem
- Department of Cardiology, Epworth and Melbourne Private Hospital, Melbourne, VIC, Australia
| | - Marco Larobina
- Department of Cardiothoracic Surgery, Royal Melbourne Hospital, Melbourne, VIC, Australia.,Department of Cardiothoracic Surgery, Melbourne Private Hospital, Parkville, VIC, Australia.,Department of Cardiothoracic Surgery, Epworth Hospital, Richmond, VIC, Australia
| | - Leeanne Grigg
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Will Wilson
- Department of Cardiology, Epworth and Melbourne Private Hospital, Melbourne, VIC, Australia
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11
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Singh B, Singh G, Tripathy A, Larobina M, Skillington P. The outcomes of the inclusion Ross in select patients ≥ 50, compared to a younger cohort. Ann Thorac Surg 2021; 113:83-91. [PMID: 33713638 DOI: 10.1016/j.athoracsur.2021.02.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 02/18/2021] [Accepted: 02/23/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND The Ross procedure is rarely considered in older patients. The aim of this study is to compare the perioperative and long-term outcomes of patients >50 years of age with younger patients after the Ross Procedure. METHODS Between 1992 and 2018, 455 patients underwent the Ross procedure utilizing the inclusion technique. Patients with redo-surgery, non-aortic procedures and unsupported root replacement were excluded. The remaining were matched for native valve morphology, valve lesion and annular manipulation and yielded 96 matched pairs. Preoperative and operative characteristics, perioperative outcomes, survival rates, valve related adverse events and valve hemodynamics were assessed. RESULTS There was no in hospital mortality. The median follow up was 11 years for both cohorts. Over-all survival at 15 years was similar: 99% (95% CI 89.8%-99.8%) for patients >50 and 98% (95% CI 89.3-99.7%) for younger patients. Patients >50 had a notable freedom from ross related re-intervention at 15 years: 94% (95% CI 84.8-97.7%) vs. 90% (95% CI 80.2-95.6%) in younger patients. The mixed model analysis revealed being fifty and older was not significantly associated with higher autograft gradient or regurgitation. Interestingly, being fifty and older correlated with decreased allograft regurgitation and stenosis. CONCLUSIONS Older patients undergoing the Ross procedure had comparable outcomes to younger patients. Patients fifty and over, that are high functioning with minimal comorbidities, should be considered for the Ross procedure.
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Affiliation(s)
| | | | - Amit Tripathy
- Peter Skillington, 300 Grattan St, Parkville VIC 3050
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12
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Lee M, Yao J, Binny S, Cheung M, Larobina M, Skillington P, Grigg L, Zentner D. 669 Long-Term Outcome of Adult Survivors of Tetralogy of Fallot. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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13
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Wijayarathne PM, Skillington P, Menahem S, Thuraisingam A, Larobina M, Grigg L. Pulmonary Allograft Versus Medtronic Freestyle Valve in Surgical Pulmonary Valve Replacement for Adults Following Correction of Tetralogy of Fallot or Its Variants. World J Pediatr Congenit Heart Surg 2019; 10:543-551. [DOI: 10.1177/2150135119859853] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Following corrective surgery in infancy/childhood for tetralogy of Fallot (TOF) or its variants, patients may eventually require pulmonary valve replacement (PVR). Debate remains over which valve is best. We compared outcomes of the Medtronic Freestyle valve with that of the pulmonary allograft valve following PVR. Methods: A retrospective study was undertaken from a single surgical practice of adult patients undergoing elective PVR between April 1993 and March 2017. The choice of valve was at the surgeon’s discretion. There was a trend toward the almost exclusive use of the more readily available Medtronic Freestyle valve since 2008. Results: One hundred fifty consecutive patients undergoing 152 elective PVRs were reviewed. Their mean age was 33.8 years. Ninety-four patients had a Medtronic Freestyle valve, while 58 had a pulmonary allograft valve. There were no operative or 30-day mortality. The freedom from reintervention at 5 and 10 years was 98% and 98% for the pulmonary allograft and 99% and 89% for the Medtronic Freestyle. There was no significant difference in the rate of reintervention, though this was colored by higher pulmonary gradients across the Medtronic Freestyle despite its shorter follow-up. Conclusions: Pulmonary valve replacement following previous surgical repair of TOF or its variants was found to be safe with no significant differences in mortality or reintervention between either valve. Although the Medtronic Freestyle valve had a greater tendency toward pulmonary stenosis, additional follow-up is needed to further document its long-term outcomes.
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Affiliation(s)
| | - Peter Skillington
- Department of Cardiothoracic Surgery, Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Department of Cardiothoracic Surgery, Melbourne Private Hospital, Parkville, Victoria, Australia
- Department of Cardiothoracic Surgery, Epworth Hospital, Richmond, Victoria, Australia
| | - Samuel Menahem
- Department of Cardiology, Epworth and Melbourne Private Hospital, Melbourne, Victoria, Australia
- School of Clinical Sciences, Monash Health, Monash University, Clayton, Victoria, Australia
| | - Amalan Thuraisingam
- Department of Cardiothoracic Surgery, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Marco Larobina
- Department of Cardiothoracic Surgery, Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Department of Cardiothoracic Surgery, Melbourne Private Hospital, Parkville, Victoria, Australia
- Department of Cardiothoracic Surgery, Epworth Hospital, Richmond, Victoria, Australia
| | - Leeanne Grigg
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
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Fricke T, Buratto E, Wynne R, Larobina M, Grigg L, Skillington P. Long-Term Pulmonary Valve Function After the Ross Procedure. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.02.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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15
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Thuraisingam A, Skillington P, Larobina M, Wijayarathne P. Comparing the Long-Term Outcome of Right Ventricle to Pulmonary Artery Conduit Insertion Using the Medtronic Freestyle Porcine Valve Versus Pulmonary Allograft Valve in Adult Patients With Congenital Heart Disease. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.02.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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16
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Litton E, Bass F, Delaney A, Hillis G, Marasco S, McGuinness S, Myles PS, Reid CM, Smith JA, Bagshaw SM, Keri-Anne Cowdrey HB, Frengley R, Ferrier J, Gilder E, Henderson S, Larobina M, Merthens J, Morgan M, Navarra L, Rudas M, Turner L, Reid K, Wise M, Young N, Young P, McGiffin D, Duncan J, Kaczmarek M, Seevanayagam S, Shaw M, Shardey G, Skillington P, Chorley T, Baker L, Zhang B, Bright C, Baker R, Canning N, Gilfillan, Kruger R, Fayers T, Kyte M, Doran C, Smith J, Baxter H, Seah P, Scaybrook S, James A, Goodwin K, Dignan R, Hewitt N, Gerrard K, Curtis L, Smith J, Baxter H, Tiruvoipati R, Broukal N, Wolfenden H, Muir, Worthington M, Wong C, Tatoulis J, Wynne R, Marshman D, Sze D, Wilson M, Turner L, Passage J, Kolybaba M, Fermanis G, Newbon P, Passage J, Kolybaba M, Newcomb A, Mack J, Duve K, Jansz P, Hunter T, Bissaker P, Dennis N, Burke N, Yadav S, Cooper K, Chard R, Halaka M, Tran L, Huq M, Billah B, Reid CM. Six-Month Outcomes After High-Risk Coronary Artery Bypass Graft Surgery and Preoperative Intra-aortic Balloon Counterpulsation Use: An Inception Cohort Study. J Cardiothorac Vasc Anesth 2018; 32:2067-2073. [DOI: 10.1053/j.jvca.2018.01.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Indexed: 11/11/2022]
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17
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Dawson L, Yao J, Skillington P, Grigg L. 0379 A Rare Case of Incidental Left Ventricular Pseudoaneurysm as a Complication of Mitral Valve Surgery. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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18
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Wijayarathne P, Thuraisingam A, Menahem S, Grigg L, Skillington P. Medtronic Freestyle Versus Pulmonary Allograft Valve in Surgical Pulmonary Valve Replacement for Adults Following Correction of Tetralogy of Fallot or Variants. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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19
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Hawson J, Skillington P, Pol D, Grigg L. A Case Report of Late Atrial Septal Defect Occlusion Device Erosion into the Aorta. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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20
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Ahmad T, Thuraisingam A, Larobina M, Skillington P. Surgical Relief of Left Ventricular Outflow Tract Obstruction in Adults With Congenital Aortic Stenosis and Associated Aortic Annulus Hypoplasia and/or Subaortic Obstruction. Heart Lung Circ 2017; 27:635-643. [PMID: 28655532 DOI: 10.1016/j.hlc.2017.05.129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 04/05/2017] [Accepted: 05/08/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND In children and adolescents, a Ross/Konno operation is commonly done to both enlarge the aortic root and provide a competent aortic valve with relief of left ventricular outflow tract obstruction (LVOTO). Optimum management is not so straightforward in adults. METHODS Between 1995 and 2014, 16 patients of mean age 39.4 years (18-57 years) with hypoplastic aortic annulus (AA) measuring 20mm and less, and mean aortic valve/LVOT gradient of 61mmHg (30-70mmHg) presented for surgery. RESULTS Eight patients with mean LVOT/AA diameter 19.6mm (18-20mm) underwent an "inclusion-cylinder" type Ross procedure (RP). Eight patients with more severe LVOT/AA obstruction, with mean diameter of 17.4mm (16-19mm) underwent mechanical aortic valve replacement (AVR) with standard Konno-type aortoventriculoplasty. There was zero early and late mortality; with mean follow-up of 11.6 years (3-21 years) in the Ross group and 6 years (2-10 years) in the Konno-AVR group. One patient in the Konno-AVR group had reoperation after 2 years for RVOT obstruction. The postoperative echocardiograms of these patients at last follow-up show residual mean gradient across LVOT/AA of 4.4mmHg (2-6mmHg) after RP, and 11.9mmHg (8-17mmHg) after Konno-AVR. CONCLUSIONS In adults, the "inclusion-cylinder" Ross-procedure is a good alternative for mild to moderate aortic root hypoplasia. However, for cases with severe LVOT obstruction, a Ross-Konno is not possible with the same method of autologous support used in a non-Konno RP, and this could be expected to have an impact on late durability and the need for further intervention, in a group that has already undergone multiple procedures in childhood. Both methods of RP and Konno-AVR lead to excellent early and late results.
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Affiliation(s)
- Tanveer Ahmad
- Department of Cardiothoracic Surgery, Royal Melbourne Hospital, Melbourne, Vic, Australia.
| | - Amalan Thuraisingam
- Department of Cardiothoracic Surgery, Royal Melbourne Hospital, Melbourne, Vic, Australia
| | - Marco Larobina
- Department of Cardiothoracic Surgery, Royal Melbourne Hospital, Melbourne, Vic, Australia
| | - Peter Skillington
- Department of Cardiothoracic Surgery, Royal Melbourne Hospital, Melbourne, Vic, Australia
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21
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Chan DY, Skillington P, Laufer E. Adult Scimitar Syndrome: A Surgical Approach. Heart Lung Circ 2015; 24:e115-7. [DOI: 10.1016/j.hlc.2015.01.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Revised: 12/26/2014] [Accepted: 01/13/2015] [Indexed: 01/08/2023]
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22
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Keenan N, Larobina M, Skillington P. Early outcomes following pulmonary valve replacement with the medtronic freestyle stentless porcine root bioprosthesis. Heart Lung Circ 2015. [DOI: 10.1016/j.hlc.2014.12.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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23
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Larobina M, Keenan N, Wynne R, Zentner D, Naidu P, Wilson W, Balding L, Grigg L, Skillington P. Aortic reoperation in adults with corrected Conotruncal defects. Heart Lung Circ 2015. [DOI: 10.1016/j.hlc.2015.06.728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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24
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Skillington P, Larobina M, Grigg L, Balding L, Zentner D, Wilson W. Surgical relief of left ventricular outflow tract obstruction in adults with congenital aortic stenosis and associated aortic annulus hypoplasia and/or subaortic obstruction. Heart Lung Circ 2015. [DOI: 10.1016/j.hlc.2015.06.706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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25
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Yacoub MH, El-Hamamsy I, Sievers HH, Carabello BA, Bonow RO, Stelzer P, da Costa FDA, Schäfers HJ, Skillington P, Charitos EI, Luciani GB, Takkenberg JJM. Under-use of the Ross operation--a lost opportunity. Lancet 2014; 384:559-560. [PMID: 25131967 DOI: 10.1016/s0140-6736(14)61090-4] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Magdi H Yacoub
- Magdi Yacoub Institute, Imperial College, London UB9 6JH, UK.
| | | | | | | | - Robert O Bonow
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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26
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Hardikar A, Skillington P, Shardey G, Smith J. Guidelines for the establishment of an adult cardiac surgery unit (CSU). Heart Lung Circ 2013; 22:699-702. [PMID: 23928035 DOI: 10.1016/j.hlc.2013.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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27
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Hallam J, Skillington P, Law SS, Nordstrand I, Tatoulis J. A Review of Deep Sternal Wound Infection Rates and Prevention Practices in Cardiac Surgery. Heart Lung Circ 2011. [DOI: 10.1016/j.hlc.2010.11.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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28
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Abstract
We describe a case of left-sided partial anomalous pulmonary venous connection diagnosed in the setting of a respiratory illness affecting the right lung, which presumably elevated pulmonary pressures and worsened right-to-left shunting. The anatomical configuration appears to be highly unusual in this case, with separate supracardiac connections of the left upper pulmonary vein (LUPV) to a vertical vein (draining to the innominate vein) and the left lower pulmonary vein to the azygos vein. Successful surgical repair was undertaken with direct anastomosis of the LUPV to the left atrial appendage and creation of an intra-superior vena cava baffle to redirect azygos vein flow to the left atrium.
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Affiliation(s)
- William M Wilson
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia.
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29
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Wilson W, Grigg L, Skillington P. Long-term Follow-up after Aortic Valve Replacement: The Impact of Pre-operative Valve Lesion on LV Size. Heart Lung Circ 2010. [DOI: 10.1016/j.hlc.2010.06.574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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30
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Reid C, Billah B, Dinh D, Smith J, Skillington P, Yii M, Seevanayagam S, Mohajeri M, Shardey G. An Australian risk prediction model for 30-day mortality after isolated coronary artery bypass: The AusSCORE. J Thorac Cardiovasc Surg 2009; 138:904-10. [DOI: 10.1016/j.jtcvs.2009.03.020] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2007] [Revised: 01/18/2009] [Accepted: 03/08/2009] [Indexed: 10/20/2022]
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31
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Conaglen P, Luthra S, Skillington P. Comparison of reduction ascending aortoplasty and ascending aortic replacement for bicuspid valve related aortopathy in young adult patients undergoing aortic valve replacement--long-term follow-up. Heart Lung Circ 2009; 18:337-42. [PMID: 19446496 DOI: 10.1016/j.hlc.2009.03.049] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2008] [Revised: 03/14/2009] [Accepted: 03/28/2009] [Indexed: 12/11/2022]
Abstract
BACKGROUND We aimed to determine the long-term outcomes of reduction ascending aortoplasty and ascending aortic replacement. A secondary aim was to document our experience with the long-term "growth" of woven Dacron grafts. METHODS Over a nine-year period (1992-2001), 154 patients underwent aortic valve replacement using the Ross procedure for bicuspid aortic valve disease (BAV). Twenty-five also underwent reduction ascending aortoplasty (RAA), and 16 underwent ascending aorta replacement (AAR), using a Dacron graft. Preoperative diameters were measured prospectively. Patients had a follow-up CT chest between January and December 2007 to measure the mid-ascending aortic diameter. RESULTS Mean age at operation was 31.8+/-13.5 years (RAA), and 40.0+/-8.6 years (AAR) (p=NS). Mean follow-up was 101 months (+/-43.0, 95% CI) in the RAA group, and 107 months (+/-29.0, 95% CI) in the AAR group. Mean pre-operative diameter in the RAA group was 41.5mm (+/-11.8, 95% CI) and in the AAR group 46.2mm (+/-7.8, 95% CI) (p=0.004). Mean follow-up diameter in the RAA group was 35.4mm (+/-4.6, 95% CI) and in the AAR group 31.9 mm (+/-6.8, 95% CI) (p=0.003). Growth of the woven Dacron prosthesis was 23.4% (+/-26.8, 95% CI) in the 107-month follow-up period. There was no early or late mortality and no further aortic surgery during follow-up. CONCLUSIONS We have demonstrated satisfactory long-term outcomes with both RAA and AAR in patients with BAV related aortopathy who have undergone the Ross procedure. We have noted a greater diameter reduction with AAR when compared with RAA over nine years. In this series, "growth" of the woven Dacron grafts occurred, however individual measures did not correlate with other studies.
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Affiliation(s)
- Paul Conaglen
- Department of Cardiothoracic Surgery, Royal Melbourne Hospital, Royal Parade, Parkville, 3050 Melbourne, Australia.
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32
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Liava'a M, Theodore S, Skillington P. Re-implantation of an anomalous right coronary artery arising from the left coronary sinus and coursing between the great arteries. J Card Surg 2009; 24:120-1. [PMID: 19267818 DOI: 10.1111/j.1540-8191.2008.00713.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The patient with a coronary artery anomaly remains a treatment dilemma. We present a 62-year-old woman who underwent re-implantation of her anomalous right coronary artery (ARCA) from the left coronary sinus and describe our techniques according to potential anatomic variations of ARCA. The ARCA from the left coronary sinus is increasingly being recognized as a cause of angina, acute myocardial infarction, syncope, and sudden death. We describe a case that was treated by direct coronary artery re-implantation into the right coronary sinus and suggest that this technique be the first considered when planning surgical correction.
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Affiliation(s)
- Matthew Liava'a
- Department of Cardiothoracic Surgery, Royal Melbourne Hospital, Victoria, Australia.
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33
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Abstract
Adult presentation with myocardial infarction in anomalous origin of the left main coronary artery from the pulmonary artery is rare. We describe the different coronary flow physiology in the adult form. A double-conduit repair with a separate feeder vessel to each limb of the left coronary circulation may be necessary to balance the myocardial demand and supply in large systemic collateral coronary beds. The report describes the use of the left internal mammary and radial artery for repair.
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Affiliation(s)
- Suvitesh Luthra
- Department of Cardiology and Cardiothoracic Surgery, Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia.
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34
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Buxton BF, Skillington P. Invited Commentary. Ann Thorac Surg 2008; 85:1245-6. [DOI: 10.1016/j.athoracsur.2008.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2008] [Revised: 01/01/2008] [Accepted: 01/03/2008] [Indexed: 10/22/2022]
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35
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Freeman M, Clark D, Andrianopoulos N, Shardey G, Buxton B, Dinh D, Yan B, Smith J, Skillington P, Ajani AE, Farouque O, Duffy SJ, Reid C. Predictors of 1-Year Mortality of Patients Undergoing Coronary Artery Bypass Grafting (CABG) Compared to Percutaneous Coronary Intervention (PCI)—Insights From Two Large Multi-centre Australian Registries. Heart Lung Circ 2008. [DOI: 10.1016/j.hlc.2008.05.162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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36
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Ahmar W, Aggarwal A, Skillington P, Atkinson N. Closure of patent Potts shunt with aortic endoluminal stent graft. Cardiovascular Revascularization Medicine 2006; 7:192-4. [PMID: 16945829 DOI: 10.1016/j.carrev.2006.03.102] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2006] [Revised: 03/21/2006] [Accepted: 03/21/2006] [Indexed: 11/23/2022]
Abstract
Pulmonary hypertension secondary to residual Potts shunt is not an uncommon phenomenon. A 59-year-old male with a history of tetralogy of Fallot was noted, on a full heart study, to have persistent pulmonary hypertension, normal left ventricular function, severe aortic regurgitation, and a residual Potts shunt. A previous surgical attempt at closure of the shunt during definitive repair was unsuccessful. An aortic endoluminal stent graft was deployed to definitively close the shunt. There was a subsequent normalization of pulmonary pressures following Potts shunt closure. The patient will now proceed with surgical aortic root repair and aortic valve replacement.
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Affiliation(s)
- Walid Ahmar
- Department of Cardiology, The Melbourne Heart Center, The Royal Melbourne Hospital, Parkville, Victoria, Australia.
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37
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38
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Affiliation(s)
- S S M Chen
- The Victorian Heart Centre, The Epworth Hospital, Melbourne, Victoria, Australia.
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39
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Affiliation(s)
- P Skillington
- National Cardiac Surgery Database Committee, Melbourne, Australia.
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40
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Abstract
Acute dissection of the ascending aorta is a rare, potentially fatal complication of cardiac surgery. During surgery patients with long-standing hypertension and atheromatous arterial disease require careful handling and cannulation of the aorta and aggressive intra-operative and postoperative management of aortic pressure. We present the successful treatment of a patient with acute aortic dissection following elective coronary artery surgery.
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Affiliation(s)
- P Subramaniam
- Cardiothoracic Unit, Royal Melbourne Hospital, Parkville, Victoria, Australia
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41
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Abstract
The incidence of the 'heparin-rebound' phenomenon after protamine neutralization of systemic heparinization required for cardiopulmonary bypass (CPB) was investigated. Heparin-effect was detected in 43% of patients studied at 2 h, 31% at 4 h, and 37% at 8 h after reversal of circuit heparin on CPB. Heparin-rebound was shown to be associated with a small but significant increase in postoperative bleeding which was not of clinical importance.
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Affiliation(s)
- P Subramaniam
- Cardiothoracic Unit, Royal Melbourne Hospital, Parkville, Victoria, Australia
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42
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Sathe S, Warren R, Vohra J, Skillington P, Hunt D. Coronary-pulmonary artery fistula arising distal to obstructive coronary lesions. Cardiology 1992; 80:77-80. [PMID: 1555219 DOI: 10.1159/000174982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
We report 2 cases of coronary-pulmonary artery fistulae (CPF) arising distal to obstructive coronary artery disease. The fistula in the first patient was in the form of a tortuous dilatation of the distal portion of the right coronary artery and opened into the right pulmonary artery. In the second case, the fistula, a plexus of vessels, arose from the left anterior descending artery and entered the left pulmonary artery. Both the fistulae were successfully ligated at the time of concurrent coronary artery bypass graft surgery.
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Affiliation(s)
- S Sathe
- Department of Cardiology, Royal Melbourne Hospital, Victoria, Australia
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