SciCombinator

Discover the most talked about and latest scientific content & concepts.

Journal: European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery

28

The goal of this study was to investigate alternative strategies to the sternal resection in the treatment of post-sternotomy osteomyelitis. We report our experience in the treatment of chronic infection of median sternotomy following open heart surgery without sternal resection.

Concepts: Sternum, Cardiothoracic surgery, Cardiac surgery

28

Reoperation for failing stentless aortic valve replacement is a technically demanding procedure that has traditionally been tackled in one of two ways: either root replacement or the more conservative option of implanting a stented valve within the valve. We sought to determine the relative operative risks, follow-up status and medium to long-term survival of these two methods.

Concepts: Derivative, Left ventricle, Aortic valve, Valve, Valve Corporation, Aortic valve replacement, Aortic insufficiency

28

A 36-year old woman presented with a 5-year history of progressive dysphagia. The barium swallow of the oesophagus revealed an oblique extrinsic defect consistent with an aberrant right subclavian artery. A computed tomography angiogram confirmed the diagnosis. Surgical correction is indicated for dysphagia lusoria in association with an aberrant right subclavian artery. The patient underwent surgical repair through the right supraclavicular approach, which provided a good exposure. We describe the use of this approach, which avoids the possible complications of thoracotomy or sternotomy in the surgical management of dysphagia lusoria.

Concepts: Medical imaging, Common carotid artery, Brachiocephalic artery, Subclavian vein, Vertebral artery, Subclavian artery, Aberrant subclavian artery

28

We report a case with a very rare complication of transcatheter aortic valve implantation. Rupture of the NovaFlex balloon (Edwards transfemoral balloon catheter) occurred during the inflation of the Edwards SAPIEN valve, resulting in dissection of the right common and external iliac arteries during withdrawal of the balloon catheter. The NovaFlex balloon is a part of the Edwards NovaFlex XT transfemoral delivery system.

Concepts: Right-wing politics, External iliac artery, Aortic valve, Internal iliac artery, Arteries, Iliac artery, Iliac vein, X-Force

28

The classic Morrow technique for hypertrophic obstructive cardiomyopathy (HOCM) in patients with simultaneous obstruction of left ventricular (LV) midcavity and right ventricular outflow tract (RVOT) combined with extreme left ventricular hypertrophy, is not effective. A new technique for HOCM surgical correction in patients with severe hypertrophy is proposed.

Concepts: Cardiology, Cardiomyopathy, Left-wing politics, Left ventricular hypertrophy, Hypertrophic cardiomyopathy, Political spectrum, Hypertrophy

28

We report a novel surgical strategy for the resection of a rare type of posterior mediastinal tumour in a young patient. A melanotic schwannoma arose from the left thoracic sympathetic chain, adjacent to the origin of the artery of Adamkiewicz. Successful excision of this tumour via a minimally invasive approach without arterial or spinal cord injury was possible with the aid of neurological monitoring using spinal-evoked potentials.

Concepts: Blood, Hospital, Heart, Surgery, Minimally invasive, Mediastinal tumor, Mediastinum, Thoracic cavity

28

Several techniques exist for the repair of complex pectus excavatum. The placement of retrosternal metal bars improves the results by reducing the recurrence rate, but entails several possible risks, complications and disadvantages. A new method, specifically conceived for the repair of severe, asymmetric forms in adult patients, is reported. The corrected bone is fixed in the proper position by two, patient-customized, titanium struts, externally screwed to the manubrium and sternal body. Any retrosternal bar is thus avoided, reducing possible complications, without hampering the chest wall dynamic. In this particularly difficult issue, this technique provides long-term good functional, mechanical and cosmetic results and does not entail a second surgery for struts removal.

Concepts: Heart, Pectus excavatum, Chest, Sternum, Pectus carinatum, Adult, Moral hazard, Fee tail

27

Air embolism is a rare complication of computed tomography (CT)-guided preoperative marking of peripheral pulmonary nodules. Here, we describe a new CT-guided marking method, which allows the quick intraoperative identification of peripheral pulmonary nodules and avoids this complication. This method does not require piercing of the pulmonary parenchyma and uses an 18-gauge indwelling catheter and a central venous catheter with a guidewire. Between July 2009 and January 2013, 16 patients underwent this procedure and could be intraoperatively diagnosed without any air embolisms. No postoperative complications were observed in this series. We believe that this simple technique is effective and will not cause severe complications.

Concepts: Lung, Central venous catheter, Catheter, Catheters, Peripheral venous catheter, Parenchyma, Embolism, Air embolism

27

OBJECTIVES: Atrial fibrillation (AF) is a significant risk factor for embolic stroke originating from the left atrial appendage (LAA). This is the first report of long-term safety and efficacy data on LAA closure using a novel epicardial LAA clip device in patients undergoing cardiac surgery. METHODS: Forty patients with AF were enrolled in this prospective ‘first-in-man’ trial. The inclusion criterion was elective cardiac surgery in adult patients with AF for which a concomitant ablation procedure was planned. Intraoperative transoesophageal echocardiography (TEE) was used to exclude LAA thrombus at baseline and evaluate LAA perfusion after the procedure, while computed tomography (CT) was used for serial imagery workup at baseline, 3-, 12-, 24- and 36-month follow-up. RESULTS: Early mortality was 10% due to non-device-related reasons, and thus 36 patients were included in the follow-up consisting of 1285 patient-days and mean duration of 3.5 ± 0.5 years. On CT, clips were found to be stable, showing no secondary dislocation 36 months after surgery. No intracardial thrombi were seen, none of the LAA was reperfused and in regard to LAA stump, none of the patients demonstrated a residual neck >1 cm. Apart from one unrelated transient ischaemic attack (TIA) that occurred 2 years after surgery in a patient with carotid plaque, no other strokes and/or neurological events demonstrated in any of the studied patients during follow-up. CONCLUSION: This is the first prospective trial in which concomitant epicardial LAA occlusion using this novel epicardial LAA clip device is 100% effective, safe and durable in the long term. Closure of the LAA by epicardial clipping is applicable to all-comers regardless of LAA morphology. Minimal access epicardial LAA clip closure may become an interesting therapeutic option for patients in AF who are not amenable to anticoagulation and/or catheter closure. Further data are necessary to establish LAA occlusion as a true and viable therapy for stroke prevention. CLINICAL TRIAL REGISTRATION: The trial is registered at www.ClinicalTrials.gov, reference: NCT00567515.

Concepts: Heart, Stroke, Atrial fibrillation, Transient ischemic attack, Avicenna, Thrombus, Left atrial appendage occlusion, Left atrial appendage

27

OBJECTIVES: Phrenic nerve injury after paediatric heart surgery is associated with significant morbidity. Surgical plication of the diaphragm is believed to be beneficial to the patient, with difficult weaning from ventilation; however, the optimal timing remains unclear. We aimed to compare the outcome after two different strategies for treating hemidiaphragmatic paresis. METHODS: A retrospective analysis of all patients with paresis of the diaphragm between 2000 and 2010 was performed, with special attention to the rate of reintubations, ventilation and intensive care unit (ICU) stay and the rate of plication. In 2005, the strategy for treating diaphragmatic paresis in our institution changed from conservative treatment with plication after multiple extubation efforts towards an aggressive one with plication after a single unsuccessful extubation. We compared the outcome of all patients and that of the newborns separately from the two periods. RESULTS: During the study period, 148 patients with diaphragmatic paresis were diagnosed and included. Median age at the cardiac operation was 7 months (1 day-18 years), ventilation time ranged from 4 h to 41 days (median 7 days), 42 (28.4%) of the patients required at least one reintubation and ICU stay ranged from 2 to 63 days (median 11 days). A total of 63 plications were performed-5 (9%) before 2004 and 58 (62%) after 2005, P < 0.001. There were no significant differences in the ventilation time-6 (1-40) vs 8 (0-41) days, P = 0.36, reintubation rate-28 vs 29%, P = 0.85 and ICU stay-10 (3-63) vs 12 (2-55) days, P = 0.41 between both groups. The newborn patients, treated with the different strategies, also did not differ significantly in their outcome: ventilation time-12 (2-40) vs 11.5 (3-34) days, P = 0.38; reintubation rate-43 vs 41%, P = 0.62; ICU stay-16 (6-63) vs 15 (7-55) days, P = 0.55. CONCLUSIONS: Changing the strategy for phrenic nerve injury after paediatric heart surgery towards a more aggressive one with early plication of the diaphragm was not associated with the better outcome. Prospective randomized studies are needed to determine the optimal management of this complication.

Concepts: Infant, Physician, Thoracic diaphragm, Phrenic nerve, Inferior phrenic arteries