390 research outputs found
Tremendous bleeding complication after vacuum-assisted sternal closure
No full textVacuum-assisted closure (VAC) of complex infected wounds has recently gained popularity among various surgical specialties. The system is based on the application of negative pressure by controlled suction to the wound surface. The effectiveness of the VAC System on microcirculation and the promotion of granulation tissue proliferation are proved. In our case report we illustrate a scenario were a patient developed severe bleeding from the ascending aorta by penetration of wire fragments in the vessel. We conclude that all free particles in the sternum have to be removed completely before negative pressure is used
Hybrid debranching and TEVAR of the aortic arch off-pump, in re-do patients with complicated chronic type-A aortic dissections : a critical report
No full textBackground: Patients suffering from acute type A aortic dissection undergo replacement of the ascending aorta, the proximal hemiarch or complete aortic arch, depending on the extent of the individual pathology. In a subset of these treated patients, secondary pathologies of the distal anastomosis or the remaining distal part of the aorta occur. The treatment of these pathologies is challenging, requiring major surgical re-do procedures with aortic arch replacement under extracorporeal circulation and hypothermic circulatory arrest.
Methods: We report our experience of five patients with complex aortic pathologies after previous aortic surgery treated with a single stage re-do hybrid procedure, consisting of bypass grafting of the supraaortic branches off-pump, stent graft placement for endovascular aortic repair (TEVAR) and surgical debranching of the aortic arch.
Results: In all patients the surgical vascular grafts and stent grafts were deployed successfully, there were no intraoperative deaths. Four out of five patients were discharged from hospital in good clinical condition. One patient died postoperatively due to cardiac tamponade. In one patient a type I endoleak persisted leading to occlusion of a bypass branch requiring surgical revision at one year after debranching.
Conclusion: We discuss the prerequisites, all steps and potential pitfalls of this hybrid aortic arch replacement. The current procedure avoids cardiopulmonary bypass and circulatory arrest, which may benefit early patient outcome; however, patient and device selection plays a key role for immediate success and midterm outcomes. In addition, precise procedural planning and development of customized stents may help to develop this procedure into a true alternative for conventional aortic arch replacement
Saccular ascending aorta aneurysm: report of an unusual presentation
No full textWe describe an unusual presentation of a large saccular aneurysm of the ascending aorta, mimicking an acute coronary syndrome. The compression of the aneurysm on the left main coronary artery was probably the cause of these confusing symptoms. Our experience confirms the fundamental role of modern cardiac imaging techniques in the differential diagnosis of these unusual cases and in the planning of the correct surgical procedure
Coronary artery bypass surgery in the elderly : is it worthwhile?
No full textObjectives: To evaluate the early outcomes after coronary surgery in the elderly.
Methods: A retrospective analysis (April 1995- January 2012) of mortality, morbidity and hospital stay, derived from a single surgeon’s practice. Outcomes of patients over 70 (group A, n=785) were compared with those of controls under 70 (group B, n=2772).
Results: Intervention rate was significantly higher (1502/106 vs 467/106, p<0.0001). There were significantly fewer single and quintuple grafts, and significantly more double grafts in group A. The use of an internal thoracic artery (ITA) was lower in group A (748/785, 95.3% vs 2695/2772, 97.2%, p=0.006). Mortality for the entire coronary surgical practice was 1.2%. The overall mortality was 2.7% in group A and 0.8% in group B (p<0.0001). Freedom from any post- operative complication occurred in 57.7% in group A and in 75.6% in group B (p<0.0001). Cardiac complications (except for perioperative MI and atrial flutter) were significantly higher in group A, as were major neurological, renal and respiratory complications, as well as minor wound complications. All complications resulted in patient morbidity but cerebrovascular accident had the worst impact, contributing to perioperative death in 8 of the 18 cases ingroupAandin4ofthe24casesingroupB (p=0.049). Average length of stay on intensive care was similar (1.19±1.84 days for group A and 1.13±1.48 days for group B, p=0.38). The average HDU stay was longer in group A (1.43±2.70 vs 0.95±3.68 days, p=0.006) as was the average ward stay (4.00±3.33 vs 3.25±2.23 days, p<0.0001).
Conclusions: Although mortality and morbidity remain significantly higher, taken in the context of the overall clinical problem, cardiac surgery has much to offer in this select group of patients.peer-reviewe
Dysphagia in an adult tetralogy of fallot with double aortic arch
No full textDouble aortic arch (DAA) is a common vascular ring. It may occur in isolation or coexist with
various types of congenital heart disease . The anomaly usually presents in early infancy. This
reports a 23yr old male presenting with dysphagia, who was found to have a double aortic arch and
tetralogy of Fallot .Both lesions were successfully corrected surgically.peer-reviewe
Sixteen year retrospective analysis of rheumatic and non-rheumatic heart disease patients undergoing valve procedures at Groote Schuur Hospital first incidence single aortic and mitral valve replacement
No full textIncludes abstract.Includes bibliographical references.Rheumatic heart disease is still the most common cause of valvular heart lesions requiring replacement or repair procedures worldwide. In South Africa, where there is an interesting mix of first and third world dynamics, factors sustaining the epidemic of rheumatic disease are still commonplace. The choice of appropriate valve procedure and prosthesis in our setting will depend on an adequate knowledge of short and long term outcomes of valve replacement and repair. The aim of this thesis was to evaluate the demographics and presentation of our rheumatic and non-rheumatic patients and to determine if our current implantation choices could be validated
René Géronimo Favaloro : pioneer of Cardiac Surgery
No full textDr. René G. Favaloro moved to the Cleveland Clinic in 1962 and proceeded to reshape the face of cardiac surgery as we knew it. Together with his colleagues at the Cleveland Clinic, Drs. Effler, Sones, Proudfit, Groves, Sheldon and countless others, he contributed to the double internal mammary arterymyocardial implantation by the Vineberg method, and by May 1967, he reconstructed the right coronary artery by the saphenous vein graft interposition. These landmark procedures paved the way for the aorto-coronary saphenous vein bypass graft in October 1967. Many similar breakthroughs ensued, with the application of the bypass technique to the left coronary artery, the combination of coronary artery bypass graft with left ventricular reconstruction and valve repair/replacement and finally, by December, a double bypass to the right coronary artery and anterior descending branch of the left coronary artery. In June, 1971, Dr. Favaloro decided to leave the Cleveland Clinic and return to Argentina where he created a medical centre, a teaching unit, a research department and finally an Institute of Cardiology and Cardiovascular Surgery. This was his greatest personal ambition. Over and above his brilliant mind and craft, Dr. Favaloro was a man of integrity, courage, honesty and humility, whose name will never cease to reverberate throughout the history of medicine.peer-reviewe
The role of cardiopulmonary bypass in the management of retrohepatic vena cava injury - A case report and review of the literature
No full textInjuries to the retrohepatic vena cava are extremely rare and are associated with an operative mortality of up to 50% even in high volume trauma centres. We present a patient with such an injury who underwent successful repair using cardiopulmonary bypass and deep hypothermic circulatory arrest.
A 23 year old male was transferred to our unit following laparotomy with packing of the abdomen after uncontrolled haemorrhage from the retrohepatic vena cava was experienced. The patient was placed on full cardiopulmonary bypass and cooled to 20 °C before clamping of the supracoeliac aorta and inferior vena cava. This facilitated exposure of the retrohepatic cava and allowed successful primary repair of a 5 cm laceration.
Other techniques to allow repair of these injuries, such as atriocaval shunts and total vascular exclusion of the liver, are associated with a high mortality. We believe the technique described in this case report is an alternative strategy that can be used successfully to manage life threatening from the retrohepatic vena cava
Effects of remote ischaemic preconditioning on peri-operative myocardial injury and clinical outcomes in patients undergoing elective cardiac bypass surgery
No full textIschaemic heart disease (IHD) is a major cause of morbidity and mortality in the world. Coronary artery bypass graft (CABG) surgery is the revascularisation strategy of choice in a significant number of patients, particularly those with diabetes mellitus and complex coronary disease. During cardiac surgery, the myocardium is subjected to peri-operative myocardial injury (PMI), which has been associated with worse short and long-term clinical outcomes. Higher-risks patients are currently being operated on with subsequent higher risk of PMI and worse prognosis: therefore new strategies are required to potentiate the innate mechanisms of cardioprotection. In this regard, remote ischaemic preconditioning (RIPC) is a promising non-invasive intervention able to reduce PMI in these patients: however, not all the studies have shown significant cardioprotection with RIPC for a number of factors, amongst which the intensity of the preconditioning stimulus may play a significant role. We therefore investigated whether an enhanced RIPC stimulus, given with transient simultaneous multi-limb ischaemia/reperfusion, was able to reduce PMI and improve short-term clinical outcomes in patients undergoing elective cardiac surgery: we demonstrated that our preconditioning stimulus can significantly reduce PMI, length of intensive care unit (ICU) stay and incidence of atrial fibrillation (AF) in these patients. In addition, further retrospective analyses showed improved myocardial protection in preconditioned diabetic patients undergoing CABG surgery and in control CABG subjects receiving combined antegrade and retrograde cardioplegia compared to control CABG patients having antegrade cardioplegia or intermittent cross-clamp-fibrillation. We also conducted a multi-centre, double-blinded randomised control clinical trial, in which we investigated the effects of RIPC on clinical outcomes at 1 year in high-risk patients undergoing elective CABG surgery with or without valve surgery (the ERICCA trial). The results of this study are due to be presented in March 2015 and have the potential to significantly impact on clinical practice in cardiac surgery
Magnesium Alloys for use as an Intraluminal Tracheal Stent
No full textTracheal stenting is used for successful management of adult airway obstructions, including tracheal stenosis, a narrowing of the tracheal lumen due to trauma or prolonged intubation. The permanent nature of non-degradable tracheal stents makes them a treatment option of last resort for pediatric patients. Complications associated with stent removal and restenosis could be avoided with degradable tracheal stent placement. Magnesium alloys are demonstrating promise as degradable materials in orthopedic and cardiovascular applications, however the performance of magnesium alloys in the trachea remains unknown. This research explores three commercially available magnesium alloys for evaluation as degradable tracheal stents. The degradation behavior of these alloys was first evaluated in vivo as an intraluminal stent in a rat tracheal bypass model. Even after 6 months the stents persisted and degradation was assessed using microCT imaging. Significant differences in percent of total volume lost were found between alloys over time. Magnesium alloys were also evaluated in a bioreactor to simulate the airway environment and corrosion in vitro. Using ICP, the presence of magnesium from each alloy was measured in a simulated airway media and in a control media over 7 days. Significant differences in corrosion were observed between the simulated and control conditions for in vitro assessment of each alloy. Additionally, in vitro corrosion of magnesium alloys did not appear significantly different from the percent of total volume lost in vivo at the 1-week time point. This study demonstrates an approach to evaluating magnesium alloys as intraluminal tracheal stents. Further development of the alloys and stent design are required for a clinically translatable model
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