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After almost 20 years aortic root reconstruction modalities have evolved into reasonable and useful surgical measures. Short and long term results match those of aortic composite replacement. Three major restitution strategies have found widespread acceptance: Root replacement with valve reimplantation (David-Procedure), root remodeling (Yacoub-procedure), or commissural resuspension. In the wake of these modalities also isolated aortic valve repair techniques have found renewed interest in order to broaden the indication for reconstructive surgery. Some euphemistic and hence biased interpretation, however, should be considered when looking at the clinical results. Reimplantation and remodeling procedures as well as several valve repair maneuvers are technically demanding unfolding their potential only in the hands of an experienced surgeon. Definite guidelines regarding the appropriate method of restitution required to serve best in the patient's individual situation are not yet at hand although they are about to emerge.

Malignant tracheo-esophageal fistulae can be palliated with bifurcate tracheal stents. However, stents must be manufactured according to the individual anatomy. In these instances a foam cuff can result in better sealing of the fistulized area. We present a successful implantation of a bifurcate tracheal stent with foam cuff. To facilitate preoperative planning reconstruction possibilities offered by spiral computed tomography were used.

The indication for coronary bypass surgery in the elderly has been dramatically expanded in recent years. The results, however, are often contradictory. 1,538 consecutive patients undergoing cardiac surgery were divided into two groups by their age at the time of operation: younger than 75 years (n = 1,480) and 75 years and older (n = 58). These groups were compared with regard to influencing factors of early and late mortality, morbidity, and quality of life. Preoperatively, the clinical condition of the group greater than or equal to 75 years was significantly worse than the condition of the group less than 75 years (NYHA IV: greater than or equal to 75 years: 63.8%; less than 75 years: 31.9%). Cerebrovascular diseases occurred more often in the patients greater than or equal to 75 years (stroke or transient ischemic attack: greater than or equal to 75 years: 8.6%; less than 75 years: 2.3%). The necessity of carotid reconstruction prior to coronary surgery was significantly higher in the patients greater than or equal to 75 years: (greater than or equal to 75 years: 5.2%; less than 75 years: 1.5%). Diabetes mellitus could be observed in 19.0% of the patients greater than or equal to 75 years and in 10.1% of the patients less than 75 years. The preoperative ejection fraction was similar in both groups. Cardiopulmonary bypass time and crossclamping time of the aorta did not differ significantly. Both groups received approximately the same number of distal coronary anastomoses. Rethoracotomy due to hemorrhage had been observed more often in the older group (greater than or equal to 75 years: 8.6%; less than 75 years: 4.5%).(ABSTRACT TRUNCATED AT 250 WORDS)