1,721,008 research outputs found
Sternotomy Techniques
No full textIf it be established that median thoracic incision is a fairly safe procedure, I have no doubt that it will constitute the most generally useful route to the thoracic organs.
And if once a safe route is established a grate field for surgical interference lies open
H. Milton (1897
Sternal Wound Complications
No full textSternal wound complications vary from persistent chest pain and sternal instability to partial or complete wound dehiscence and mediastinitis. Of all sternal wound complications, mediastinitis is considered the most serious; it requires surgical treatment and prolonged antibiotic therapy and continues to have a dramatic impact on patient survival, with a reported hospital mortality rate of between 10% and 20%. Gram-positive bacteria are the most commonly isolated bacteria in mediastinitis; Staphylococcus aureus or S. epidermidis are identified in 70–80% of cases. Gram-negative bacteria and fungal infections are less common. Mixed infections may account for up to 40% of cases. Special attention should be given to bacteria which have become resistant to antibiotics that are in common use as prophylaxis, in particular the methicillinresistant Staphylococcus aureus (MRSA), or those resistant to vancomycin, vancomycin intermediate-resistant S. aureus (VISA) . In addition, mediastinitis has been found to affect long-term survival and to be an independent risk factor for late mortality in patients who have undergone CABG surger
A Novel Endosurgical Prosthesis to Treat Thoracoabdominal Aortic Aneurysm in Complex Anatomy or Emergency Settings
No full textBACKGROUND: Despite improvements in operative techniques, open thoracoabdominal aortic aneurysm (TAAA) repair is complex and characterized by high mortality and morbidity rate. Less invasive techniques have been developed since 2005 for the treatment of TAAA. Unfortunately, many of these devices require custom fabrication, resulting in delay of many weeks until treatment can be delivered but crucial in critical emergency cases. We present a novel hybrid endovascular and surgical prosthesis, which was tested on five pigs, with the aim of reducing the barrier issues of endovascular therapy in such particular cases.METHODS: The principal characteristic of the proposed hybrid endovascular prosthesis is to combine a proximal and distal stented zones and, in between, a classical surgical blood tied Dacron prosthesis. The device was tested in five pigs where feasibility of implantation and acute postoperative outcomes were evaluated, including bleeding, bowel ischemia, renal function, and peripheral blood perfusion.RESULTS: In all cases, following laparotomy, the endoprosthesis was successfully implanted under fluoroscopy and the surgical prosthesis zone could be easily detected by the radio-opaque markers. No major bleeding or cardiac events occurred throughout preparation and implantation. One hour after prosthesis implantation and surgical anastomoses of all vessels were completed, normal urine output was registered, and no acidosis was detected.CONCLUSIONS: This novel graft has shown ease of endoprosthesis and visceral vessels implantation without the need of thoracotomy or extracorporeal circulation and may be useful in an emergency setting or high risk and complex anatomy TAAA unsuitable for traditional endovascular aneurysm repair, or to avoid an excess waiting time for a "custom made" prosthesis. The great adaptability of this "hybrid" prosthesis in complex anatomy for the majority of TAAA could be important in high-risk patients and in some difficult situations, such as a high risk of imminent rupture
Usability, performance and safety of a new device for degenerative mitral regurgitation: in vivo chronic evaluation
No full textOBJECTIVES: This study aimed to evaluate the usability, performance and safety of an innovative mitral valve device in the chronic setting characterized by an intraventricular bridge, which enables artificial chordae anchoring and/or direct posterior leaflet fixation. METHODS: Ten female sheep were employed and underwent device implantation. Any interference of the device with leaflet motion, ease of device use, correct chordae length estimation and implantation were evaluated. Post-procedural valve competence and device performance were verified by periodic postoperative echocardiograms and laboratory examinations. Following euthanasia, gross anatomy and histology evaluation of the hearts and valves were performed to detect tissue abnormalities and inflammation reaction related to the device. RESULTS: The procedure was successfully completed in all 10 sheep. Lengths of the 2 chordae implanted were 23 (21.5–24) mm and 23 (22.5–24) mm. The time required to suture both pairs of the artificial chordae was 2.7 ± 0.7 min. At the 3-month follow-up, left ventricular function was normal. The transvalvular peak pressure gradient was 9 (7.5–10) and the mean gradient was 4 (3.5–4) mmHg. Upon necropsy and histological evaluation, no damage to left ventricle wall, valve leaflets, chordae and papillary muscles and absence of thrombus formation and inflammatory reaction were observed. Radiological images showed neither fracture of the device nor calcifications. Laboratory tests showed no signs of haemolysis. CONCLUSIONS: In vivo late tests confirmed the ease of correct chordal length estimation prior to implantation, short operative time and usability in flailed anterior leaflet repair. The absence of negative impact of the device on mitral leaflets motion, function and structure and successful repair might suggest that the device would be useful in complex degenerative mitral disease
Anesthesia in Patient with Left Ventricular Assist Device LVAD support. A Case Report
No full textBackground; Left ventricular assist device (LVAD) implantation is not only a bridge-to-transplantation option for patients awaiting a donor's heart, but is often used as bridge-to-destination therapy in patients unsuitable for transplantation for various reasons. Device infection remains a threatening complication, which may lead to prolonged hospitalization, need to devise exchange, urgent transplantation, and even death of the patient. Infections with multidrug-resistant (MDR) organisms pose major difficulties for eradication therapy. Especially patients who are subject to continuous hospital treatments risk contamination or change of resistances spectrum. Gold standard therapy of certain organisms often fails to eradicate surface-associated colonization of implanted devices such as cardiovascular implants, while failed eradication leads to numerous complications and an increased mortality rate among the affected patients. Device infections through multidrug-resistant bacteria, such as MRSA, are often resistant even to first-line antibiotics, due to extended resistance spectrum and reduce tissue penetration in scar tissue after multiple surgical procedures. In addition, a solid biofilm on devices is often impenetrable even for suitable antibiotics because of the isolating nature of biofilms
Unconjugated Hyperbilirubinemia after Open Heart Surgery
No full textThe occurrence of hyperbilirubinaemia after heart surgery using cardiopulmonary bypass or post-operative heart failure is fairly common. Mechanism of hyperbilirubinemiais still not completely clarified, and there are so few specific therapies available for acute hepatobiliary injury. Post-operative mortality well correlates with increasing total bilirubin values, particularly for bilirubin-associate acute kidney tubular necrosis. The difficulty to reduce mortality is partially a consequence of not completely understood physiopathology. It is obvious that long-lasting CPB plays an important role, in association with hemodilution, hypotension, ischemia-reperfusion, and increasing hematic level of endogenous catecholamine with reduction of hepatic blood flow. Case report. A 68 years old man with severe mitral valve regurgitation and pulmonary hypertension and low EF 30%. Mitral valve replacement and tricuspid anuloplastic was performed. Due to low cardiac output syndrome severe hyperbilirubiemeia was seen (24 mg/dl. and unconjugated fraction 16mg/dl) days after. Phenobarbital (luminal) was started 15 mg/kg daily. Two days later the level decreased until 8 mg/dl with normalization of conjugation/unconjugation ratio.Postoperative hyperbilirubinemia is a multifactorial process caused by both impaired liver function of bilirubin transport. In case of elevated level of unconjugated fraction we suggest to use Luminal as alternative for decreasing unconjugated fraction
Method of reinforcing a sternum after a sternotomy or a sternal fracture
No full textA method for reinforcing a sternum after a sternotomy or a sternal fracture. The method includes i) applying a plurality of elongated members along at least one longitudinal lateral edge of the sternum, wherein the elongated members are each provided with a first connection part and a second connection part; ii) slidably joining a first connection part of a first elongated member with a second connection part of an adjacent preceding elongated member along the longitudinal lateral edge of the sternum; iii) slidably joining a second connection part of the first elongated member with a first connection part of an adjacent following elongated member along the same longitudinal lateral edge of the sternum; iv) fitting a projecting portion of one or more of said elongated members in an intercostal space adjacent to the longitudinal lateral edge of the sternum; and v) fixing the elongated members to the sternum
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Devices and implantation methods for treating mitral valve condition
No full textMitral valve implants and devices, kits and methods are provided for mitral valve repair. Devices comprise a body attachable onto the mitral valve annulus and a bridge connected to the body by two legs which are configured to support and position the bridge within a left ventricle (LV) of the patient when the device body is implanted, so that the legs and the bridge avoid contact with the LV walls, papillary muscles and chordae during operation of the heart. The bridge may be used to anchor valve leaflet tissue, provide support for leaflet re-modelling, possibly using external tissue, and/or anchor artificial chords used to modify and repair the operation of the mitral valve. Related medical procedures as well as kits and related utensils are also provided
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