1,721,290 research outputs found
Innovative transcatheter procedures for the treatment of heart failure
Full text linkThe prevalence of heart failure (HF) continues to rise over time, with aging of the population and increased survival of incident cases. Major improvements occurred in drug therapy but morbidity and mortality of HF patients remain high. Some non-pharmacologic approaches to HF are already part of standard treatment for HF, including implantable cardioverter-defibrillators, cardiac resynchronization therapy (CRT) and left ventricular assist devices (LVADs). A number of transcatheter treatments and devices have been developed to improve management of valvular heart diseases (VHD), and some of them are being used or tested in specific HF conditions. For example, transcatheter aortic valve implantation (TAVI) to unload the left ventricle in patients with moderate aortic stenosis (AS) and HF or TAVI for severe aortic regurgitation (AR) in patients with LVADs. Similarly, percutaneous mitral valve repair can be used to improve prognosis and quality of life in patients with functional mitral valve regurgitation, and has been proposed as a bridge-to-LVAD or to heart transplant in selected patients. Other devices have been specifically developed for the treatment of chronic HF. In this review we describe the main devices used in the treatment of HF associated with aortic and mitral valve disease, as well as novel transcatheter interventions for chronic HF with different pathophysiologic targets
Commentary: Carotid is the best alternative for femoral transcatheter aortic valve replacement?
No full textN.D
La chirurgia dell'aorta toracica alla luce delle nuove linee guida europee = Surgical treatment of the thoracic aorta according to the 2014 European guidelines
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Protezione cerebrale nella chirurgia dell'arco aortico
No full textNelle ultime decadi l’oucome dei pazienti sottoposti a chirurgia dell’aorta toracica è nettamente migliorato. Ciononostante, la chirurgia dell’aorta toracica e, in particolare, dell’arco aortico è ancora associata a una mortalità e morbilità significativamente elevate a causa di complicanze neurologiche derivanti dall’interruzione della circolazione cerebrale. I danni cerebrovascolari nella chirurgia dell’aorta toracica possono essere provocati da un’inadeguata protezione cerebrale, dall’embolia cerebrale e, in caso di dissezione aortica acuta di tipo A, da malperfusione cerebrale. L’outcome neurologico di questi pazienti dipende dalla qualità della protezione del sistema nervoso centrale durante il periodo critico di interruzione della circolazione cerebrale. Varie tecniche sono state proposte per la protezione cerebrale dal danno ischemico, come l’arresto di circolo in ipotermia profonda, la perfusione cerebrale retrograda e la perfusione cerebrale selettiva anterograda. Questa rassegna prende in esame queste tre tecniche e le strategie di protezione cerebrale evidenziandone i relativi vantaggi e limiti
When and how to replace the aortic arch for type A dissection
No full textAcute type A aortic dissection (AAAD) remains one of the most challenging diseases in cardiothoracic surgery and despite numerous innovations in medical and surgical management, early mortality remains high. The standard treatment of AAAD requires emergency surgery of the proximal aorta, preventing rupture and consequent cardiac tamponade. Resection of the primary intimal tear and repair of the aortic root and aortic valve are well-established surgical principles. However, the dissection in the aortic arch and descending untreated aorta remains. This injury is associated with the risk of subsequent false lumen dilatation potentially progressing to rupture, true lumen compression and distal malperfusion. Additionally, the dilatation of the aortic arch, the presence of a tear and retrograde dissection can all be considered indication for a total arch replacement in AAAD. In such cases a more aggressive strategy may be used, from the classic aortic arch operation to a single stage frozen elephant trunk (FET) technique or a two-stage approach such as the classical elephant trunk (ET) or the recent Lupiae technique. Although these are all feasible solutions, they are also complex and time demanding techniques requiring experience and expertise, with an in the length of cardiopulmonary bypass and both myocardial and visceral ischemia. Effective methods of cerebral, myocardial as well visceral protection are necessary to obtain acceptable results in terms of hospital mortality and morbidity. Moreover, a correct assessment of the anatomy of the dissection, through the preoperative angio CT scan, in addition to the clinical condition of the patients, remain the decision points for the best arch repair strategy to use in AAAD
The application of the “KISS principle” for the treatment of type A acute aortic dissection: Is this always right?
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Is wall stress like Wall Street when it comes to speculating on bicuspid versus tricuspid aortic valve aneurysm?
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