1,721,088 research outputs found
Sternal closure following negative pressure wound therapy: A safe approach with a new titanium device
No full textBACKGROUND: The application of negative pressure wound therapy (NPWT) in patients with deep wound infection after cardiac surgery has steadily increased worldwide. Following NPWT, in patients with concomitant sternal diastasis, preparation of the substernal structures for the sternal wires application is mandatory, with increased risk of severe complications, such as laceration of the right ventricle. The aim of this study is to present an innovative technique for sternal closure after NPWT, using the ASCS® System (ASCS atraumatic Sternum Closure System; KS Handelsvertretung Produktinovation, Bad Homburg, Germany).
METHODS: Between January 2009 and August 2012, 88 patients (mean age 64.2 ± 12.4 years) with deep wound infection and sternal diastasis received NPWT; 16 of these patients (18.2%) underwent sternal closure after NPWT with ASCS®.
RESULTS: In all 16 cases, neither sub-sternal dissection nor placement of trans- or peristernal wires was necessary. No damage to the aortocoronary bypass and ventricular rupture occurred. Minimal post-operative bleeding from Redon drains (mean 40 ± 10 ml) was present. At follow-up, deep wound infection and sternal diastasis did not occur.
CONCLUSIONS: The ASCS® System combined with NPWT in patients with postoperative deep wound infection and sternal diastasis is a feasible and safe procedure. Because preparation of the substernal structures is not necessary, this device might prevent the occurrence of severe complications. Our experience, however, is limited and larger case series are necessary to fully evaluate this new and innovative technique
Aortic Valve Stenosis in Redo Operations in Octogenarians: Transcatheter Aortic Valve Implantation or Surgical Intervention? That Is the Question
No full text
Doppia sostituzione mitro-aortica in paziente ad alto rischio: the sutureless way
No full textThe mitro-aortic disease in high-risk patients is a challenge for the cardiac surgeon because minimally invasive techniques are difficult to apply. We report the first case in the literature of a 78-year-old woman affected by severe rheumatic steno-insufficiency of aortic and mitral valves at high surgical risk. The patient was successfully treated by mitral valve replacement with a biological prosthesis and concomitant aortic valve replacement with a sutureless prosthesis
Sorin Perceval S aortic valve implantation through a mini-sternotomy approach
Full text linkWe describe a case of a 78-year-old female with chronic obstructive pulmonary disease (COPD), diabetes, obesity, impaired renal function and severe aortic valve stenosis with associated insufficiency (Video 1). The patient was
symptomatic for dyspnea (class NYHA III). Her medical history included breast cancer treated with mastectomy two years prior. The logistic Euroscore was 19.17%. After echocardiographic evaluation which excluded significant coronary artery disease, a minimally invasive sutureless aortic valve replacement (AVR) was planned
Anticoagulation with apixaban in a patient with a left ventricular assist device and gastrointestinal bleeding: A viable alternative to warfarin?
No full textRapid Deployment But Not Hasty Conclusions
No full textWe read Ensminger’s article [1] comparing outcomes of rapid deployment (RDVs) vs. conventional biological valves (CBVs). However, we feel to express some criticism as they stand in contrast to our experience [2] in this field.
Firstly, we would like to criticize nonconforming errors (Table 1) of sensitive parameters, which lead to confusion, and, if proven true, need recalculation. A potential flaw of pressure gradients analysis is the fact that the comparison is based on labeled sizes and not on patients’ annular dimension after decalcification. Since RDVs are intra-annular devices and CBVs are mainly implanted supra-annularly, the only way to compare hemodynamic data is to group patients by their annular size (e.g.: Perceval size “S” covers annular sizes from 19 mm to 21 mm, is therefore comparable to a 19 mm Intuity, which was omitted from the analysis). Therefore, hemodynamic measurements are not valid and potentially “comparing apples and oranges”. Furthermore, body surface area was not used as a variable for the propensity score matching. No information exists about the incidence of prosthesis-patient mismatch.
Higher postoperative gradients and greater incidence of stroke for “sutureless” as compared to “balloon expandable” were observed only in the isolated AVR group and not in the combined CABG+AVR group. Theoretically, gradients should not be influenced by adding bypass grafts, and with regard to stroke, it would be logical to expect an increased risk due to aortic manipulation on the ascending aorta and longer ECC times. Faced with this counter-intuitive evidences we would have liked possible explanations from the authors.
Moreover, 10% of patients in the RDV group received a valve that was withdrawn from the market for inferior functional performance, but influences results significantly. The only homogeneous results in isolated and combined groups is the need for new pacemaker implantation. We are skeptical that any conclusions can be made without analyzing risk factors for this outcome (e.g. preoperative right bundle-branch block). PERSIST, the ongoing prospective randomized trial comparing sutureless and CBVs (NCT02673697) will help us shed more light onto these issues
Radice aortica aneurismatica associate a valvola bicuspide: approccio mini-invasivo con protesi sutureless
Full text linkThe implantation of sutureless bioprosthesis is currently not recommended in patients affected by bicuspid aortic valve because lacking data and follow up. We report the first case of a patient affected by bicuspid aortic valve stenosis and aneurysm of non coronary sinus of Valsalva that underwent a successful substitution of aneurysmatic sinus and minimal invasive sutureless implantation
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