Personal experience in 207 Bentall procedures

This work is based on the greatest experience in Venezuela in the surgical treatment of the aortic root in pathologies that require a Bentall procedure. It represents the experience in the 207 cases carried out with this procedure; types of prosthetics and grafts, techniques used, observed care, results, complications, and mortality. Of Bentall’s interventions, 59 cases (27.4 %) were done with total circulatory arrest in deep hypothermia at 18 oC. As associated procedures, 21 patients received aorto-coronary bypass grafts and 10 patients also had mitral valve replacement. The overall operative mortality of the sample was 12.5 %. The success rate of this experience was 87.5 %, fully justifying the completion of the procedure in the pathology of very high mortality, especially when referring to dissections.

Hemodynamic and functional effectiveness of the patient undergoing pulmonary thromboendarterectomy

Objective: to evaluate the hemodynamic and functional effectiveness of the patient undergoing thromboendarterectomy. Methods: a descriptive study of series of cases in postoperative patients of thromboendarterectomy from 2002 to 2016 with complete records was carried out. The data collection was done with an "ex profeso" sheet of 10 demographic items, 2 of somatometry, 6 hemodynamics, 1 functional, 6 gasometric and 9 of perfusion conduction, with open and dichotomous responses. For the data analysis, descriptive statistics, U Mann-Whitney tests and Kaplan-Meier survival analysis were applied; the significance was set at p <0.05. Results: 25 patients were studied, male prevalence (68%), age 43 ± 18 years. The cardiopulmonary bypass time was 222 ± 73 min. and the aortic clamp of 121 ± 71 min; in 80%total circulatory arrest was performed for periods of 20 min and reperfusion times of 10 min between each one. 20% of the patients were managed with selective cerebral perfusion. Thromboendarterectomy decreased pulmonary vascular resistance (p <0.0001) and mean pulmonary arterial pressure (p = 0.001) and increased cardiac output (p = 0.009), PaO2 (p = 0.035) and SaO2 (p = 0.015). 72% improved the functional class from III-IV to I-II. There was mortality of 20% associated to persistence of pulmonary arterial hypertension and the three-year survival was 80%. Two patients required ECMO A-V both successful. Conclusion: Thromboendarterectomy is the treatment of choice for patients with chronic pulmonary thromboembolism, significantly improving hemodynamic and functional parameters, reflected in their quality of life and survival.