1,721,036 research outputs found
Risk factors for paravalvular leak after transcatheter aortic valve replacement
Full text linkObjective. To assess risk factors for paravalvular leak (PVL) after transcatheter aortic valve implantation (TAVI) in a large single-center cohort, including measurement of aortic valve calcification using a reproducible method.
Methods. We retrospectively analyzed preoperative contrast-enhanced multidetector computed tomography (MDCT) scans of patients who underwent TAVI in our center between 2009 and 2016. Calcium volume was calculated for each aortic cusp in the aortic valve (AV), left ventricular outflow tract (LVOT) and device-landing zone (DLZ).
Results. Overall, 539 patients were included in the study (Edwards SapienXT, n=192; Edwards Sapien3, n=206; Medtronic CoreValve EvolutR, n=44; Symetis Acurate, n=97). Median calcium volume in the DLZ was 757 mm3, with no significant differences among the four prosthesis groups. None of the patients had severe PVL. The overall incidence of mild-to-moderate PVL was 15.8% (95% CI: 12.8-19.1%). On multivariate logistic regression, DLZ calcification (p=0.00006; OR for an increase of 100 mm3 1.08; 95% CI: 1.04-1.13) and use of the CoreValve (p=0.0028; OR 4.1; 95% CI: 1.6-10 with SapienXT as reference) prosthesis were found to be associated with ≥mild PVL. In contrast, degree of oversizing (p=0.002; OR 0.97; 95% CI: 0.95-0.99), and use of Sapien3 (p=0.00005; OR 0.23; 95% CI: 0.11-0.47 with SapienXT as reference) were associated with a lower incidence of ≥mild PVL.
Conclusions. Aortic calcification volume in the DLZ is associated with residual PVL after TAVI. When taking calcification into account, the balloon-expandable prosthesis Sapien3 seems to be associated with a lower incidence of PVL
Aortic Valve Stenosis in Redo Operations in Octogenarians: Transcatheter Aortic Valve Implantation or Surgical Intervention? That Is the Question
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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
Anticoagulation with apixaban in a patient with a left ventricular assist device and gastrointestinal bleeding: A viable alternative to warfarin?
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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
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