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Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery

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https://www.readbyqxmd.com/read/27898433/transcatheter-aortic-valve-implantation-in-nonagenarians
#1
Adam Penkalla, Joerg Kempfert, Axel Unbehaun, Semih Buz, Thorsten Drews, Miralem Pasic, Volkmar Falk
OBJECTIVE: In this report, we assess the outcome of transcatheter aortic valve implantation (TAVI) in nonagenarians at our institution during a 6-year period. METHODS: Between April 2008 and July 2014, 40 patients with a mean ± SD age of 91.8 ± 2.3 years (range, 90-98 years) underwent TAVI. Thirty-three patients (82.5%) received transapical TAVI, and seven patients (17.5%) received transfemoral TAVI. Baseline characteristics were as follows: mean ± SD EuroSCORE II, 23...
November 28, 2016: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
https://www.readbyqxmd.com/read/27879533/the-angiovac-device-understanding-the-failures-on-the-road-to-success
#2
Berhane Worku, Arash Salemi, Marcus D DʼAyala, Robert F Tranbaugh, Leonard N Girardi, Iosif M Gulkarov
OBJECTIVE: Current percutaneous thromboembolectomy techniques may obviate surgical intervention in high-risk patients with iliocaval thrombus or thrombus of the right side of the heart, but typically require thrombus fragmentation and thrombolysis with associated bleeding and thromboembolic complications. The AngioVac (Angiodynamics, Latham, NY USA) device uses a percutaneous venovenous bypass circuit to aspirate intact thrombus. A review of the literature was performed with regard to the AngioVac device to determine the factors correlating with successful thrombus extraction...
November 22, 2016: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
https://www.readbyqxmd.com/read/27879532/myocardial-protection-and-financial-considerations-of-custodiol-cardioplegia-in-minimally-invasive-and-open-valve-surgery
#3
Brian W Hummel, Randall W Buss, Paul L DiGiorgi, Brittany N Laviano, Nalani A Yaeger, M Lee Lucas, George M Comas
OBJECTIVE: Single-dose antegrade crystalloid cardioplegia with Custodiol-HTK (histidine-tryptophan-ketoglutarate) has been used for many years. Its safety and efficacy were established in experimental and clinical studies. It is beneficial in complex valve surgery because it provides a long period of myocardial protection with a single dose. Thus, valve procedures (minimally invasive or open) can be performed with limited interruption. The aim of this study is to compare the use of Custodiol-HTK cardioplegia with traditional blood cardioplegia in patients undergoing minimally invasive and open valve surgery...
November 22, 2016: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
https://www.readbyqxmd.com/read/27879531/b-type-natriuretic-peptide-predicts-morbidity-and-long-term-mortality-in-coronary-artery-bypass-grafting-and-valve-surgery
#4
Kendal M Endicott, Richard L Amdur, Michael D Greenberg, Gregory D Trachiotis
OBJECTIVE: To assess whether B-type natriuretic peptide (BNP) levels are a useful predictor of morbidity and mortality as well as long-term survival in patients after coronary artery bypass grafting (CABG) and valve surgery. METHODS: A retrospective review of CABG and/or valve surgery patients from 2012 to 2015 at a single center was conducted. A total of 432 patients were identified (CABG, 295 patients; valve, 82 patients; and CABG + valve, 55 patients). B-type natriuretic peptide levels were divided into quartiles (Q1-Q4)...
November 22, 2016: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
https://www.readbyqxmd.com/read/27879530/transaortic-edge-to-edge-repair-for-functional-mitral-regurgitation-during-aortic-valve-replacement-a-13-year-experience
#5
Christos G Mihos, Maiteder Larrauri-Reyes, Judy Hung, Orlando Santana
OBJECTIVE: The study evaluated the feasibility of a transaortic edge-to-edge mitral valve repair (Alfieri stitch) for moderate or greater (≥2+) functional mitral regurgitation (MR) in high-risk patients undergoing aortic valve replacement. METHODS: We retrospectively evaluated 40 consecutive patients who underwent aortic valve replacement combined with a transaortic edge-to-edge mitral valve repair for 2+ or greater functional MR, between February 2002 and April 2015...
November 22, 2016: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
https://www.readbyqxmd.com/read/27832045/proof-of-concept-of-an-endoscopic-sutureless-valve-sizer
#6
Marco Vola, Juan Pablo Maureira, Vito Giovanni Ruggieri, Jean-François Fuzellier, Salvatore Campisi, Jean-Pierre Favre, Antoine Gerbay, Thierry A Folliguet
OBJECTIVE: In this paper, we present an endoscopic expandable sizer conceived to allow thoracoscopic aortic valve replacement with a sutureless prosthesis using a dynamic sizing of the aortic annulus. METHODS: Ten aortic torsos were prepared using a five-trocar thoracoscopic setting. Once the aortotomy was performed and the aortic valve leaflets removed, the technical feasibility of the endoscopic sizing (introduction into the trocar, expansion into the aortic annulus, determination of the valve size, and retraction) with the device was assessed...
September 2016: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
https://www.readbyqxmd.com/read/27832044/early-results-of-the-modified-right-atrial-lesion-set-for-the-cox-cryomaze-procedure
#7
Faisal Habib Cheema, Muhammad Amir Younus, Osama T Siddiqui, Muhammad Jabran Younus, Muhammad Arif Mahmood, Mohammad Bin Pervez, Harold G Roberts
OBJECTIVE: The standard right atrial lesion (RAL) set, as originally outlined in the Cox-Maze III procedure, can be technically challenging when using a cryoprobe to create the lesions. We report our initial experience with an alternative set of RALs for the surgical treatment of atrial fibrillation (AF). METHODS: Between September 2011 and January 2015, a total of 112 patients underwent a CryoMaze procedure with biatrial lesions using argon-based cryoablation (cryoprobe temperature, -160°C)...
September 2016: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
https://www.readbyqxmd.com/read/27828807/predictors-and-outcomes-of-sternotomy-conversion-and-cardiopulmonary-bypass-assistance-in-minimally-invasive-coronary-artery-bypass-grafting
#8
Maria L Rodriguez, Harry R Lapierre, Benjamin Sohmer, Jean-Philippe Ruel, Marc A Ruel
OBJECTIVE: This work's objective was to identify the determinants of conversion of minimally invasive coronary artery bypass grafting to sternotomy, with and without cardiopulmonary bypass assistance, and to compare clinical outcomes in patients who needed conversion. METHODS: This is a prospectively collected data on patients who underwent minimally invasive coronary bypass done by a single surgeon from February 2005 to September 2014. Statistical analyses were expressed as mean values ± standard deviation or proportions...
September 2016: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
https://www.readbyqxmd.com/read/27828806/mechanical-circulatory-support-heart-failure-therapy-in-motion
#9
Stephan M Ensminger, Gino Gerosa, Jan F Gummert, Volkmar Falk
Because the first generation of pulsatile-flow devices was primarily used to bridge the sickest patients to transplantation (bridge-to-transplant therapy), the current generation of continuous-flow ventricular assist devices qualifies for destination therapy for patients with advanced heart failure who are ineligible for transplantation. The first-generation devices were associated with frequent adverse events, limited mechanical durability, and patient discomfort due device size. In contrast, second-generation continuous-flow devices are smaller, more quiet, and durable, thus resulting in less complications and significantly improved survival rates...
September 2016: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
https://www.readbyqxmd.com/read/27828805/aspergilloma-of-the-lung-strategy-to-prevent-endobronchial-spillage
#10
Preety Mittal Roy, Sangeeta Khanna, Yatin Mehta, Ali Zamir Khan
Aspergilloma of the lung eroding into the airway may lead to perioperative endobronchial spillage and contamination of the normal lung. Our aim in this group of patients who are undergoing robotic- or video-assisted thoracoscopic lobectomy is to protect the contralateral lung and, if possible, uninvolved lobes of ipsilateral lung. Double-lumen endobronchial tubes do provide lung protection to the contralateral lung intraoperatively, but there is no protection to the ipsilateral lung lobes not involved by the disease process...
September 2016: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
https://www.readbyqxmd.com/read/27828804/onyx-embolization-as-single-rescue-treatment-for-ruptured-abdominal-aortic-aneurysm-after-evar
#11
Satoko Fujita, Tal Hörer, Artai Pirouzram, Asko Toivola, Göran Gruber, Thomas Larzon
A 76-year-old man who had undergone endovascular repair for an infrarenal aortic aneurysm, presented with a late type Ia endoleak 3 years after his operation. Deployment of an aortic cuff did not achieve a better seal at the proximal neck, and the aneurysm developed a rupture. We successfully treated the ruptured aneurysm using transcatheter Onyx embolization only. At 6-month and 1-year follow-ups with contrast-enhanced duplex scanning, no endoleak was seen and sac shrinkage was observed. Onyx is a relatively new liquid embolic agent that is slowly transformed into a solid state by contact with blood...
September 2016: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
https://www.readbyqxmd.com/read/27819806/pseudoaneurysm-as-a-late-complication-of-hybrid-aortic-arch-repair
#12
Cristian Rosu, Nicolas Beaulieu, Raymond Cartier, Philippe Demers
Hybrid aortic arch repair is increasingly used for the management of aortic arch aneurysm. Pseudoaneurysm is a newly described late complication of this procedure. A 57-year-old man underwent emergent supra-aortic debranching and aortic arch stent grafting after rupture of an arch aneurysm. Three years later, the patient presented with a pseudoaneurysm at the junction between the stent graft's proximal landing zone and the origin of the debranching graft. At reoperative repair, the proximal stent graft had eroded through the aortic wall at the junction of the endograft proximal landing zone and the proximal anastomosis of the debranching graft...
September 2016: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
https://www.readbyqxmd.com/read/27819805/type-iiib-endoleak-associated-with-an-infected-thoracoabdominal-endograft
#13
Nathan T Orr, Michael A Winkler, Eleftherios S Xenos
We present a 63-year-old male patient who presented with vague abdominal pain after an endoluminal thoracoabdominal aneurysm repair. He was found to have an infected endograft and an associated type IIIb endoleak. We believe that the infection contributed to the fabric degradation along the endograft and resulted in an expanding endoleak. Graft explantation was not performed because of the patient's multiple comorbidities, and the endoleak was treated with an additional stent graft and suppressive antibiotics...
September 2016: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
https://www.readbyqxmd.com/read/27662476/the-application-of-liquid-nitrogen-spray-cryotherapy-in-treatment-of-bronchial-stenosis
#14
Kelly J Janke, Abbas El-Sayed Abbas, Vishnu Ambur, Daohai Yu
OBJECTIVE: Spray cryotherapy (SCT), the application of liquid nitrogen in a noncontact form, has been demonstrated to have efficacy in treating various types of pathologic lesions of the airway when used as an adjunct with bronchoscopy. The purpose of the study was to evaluate the results of the use of bronchoscopic SCT on the airway in a single institution. METHODS: We performed a retrospective review of data collected on all patients who underwent SCT to re-establish or improve airway patency in an 11-month period...
September 2016: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
https://www.readbyqxmd.com/read/27635474/transaortic-transcatheter-aortic-valve-implantation-and-concomitant-off-pump-revascularization
#15
Hardy Baumbach, Samir Ahad, Stephan Hill, Tim Schäufele, Sara Adili, Kristina Wachter, Ulrich F W Franke
An increasing number of patients with severe aortic stenosis and concomitant critical coronary artery disease were referred to our hospital. Some of those patients were classified as high-risk patients qualifying for a transcatheter therapy with the additional need for coronary revascularization. As a consequence of their comorbidities, the established transapical as well as transfemoral approach were either not possible or not favored owing to the indispensable need for coronary revascularization. We present 4 successfully combined off-pump procedures consisting of a transcatheter aortic valve implantation (Edwards SAPIEN XT) via the transaortic approach and an off-pump coronary artery bypass grafting...
September 2016: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
https://www.readbyqxmd.com/read/27631953/new-small-diameter-forceps-for-thoracoscopic-surgery-technical-adaptations-and-initial-experiences
#16
Masaya Tamura, Yosuke Shimizu
In this report, we describe the use of new small-diameter forceps (Endo Relief forceps) for port-reduced thoracoscopic surgery. Forceps were designed with end that were the same size and shape as conventional 5-mm forceps, except that the diameter of the shaft was decreased to 2.4 mm. Endo Relief forceps were used for thoracoscopic surgery in 18 patients. We retrospectively compared the frequency of grasping error between conventional small-diameter forceps and Endo Relief group. The mean surgical time was 57...
September 2016: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
https://www.readbyqxmd.com/read/27631952/robotic-resection-of-3-cm-and-larger-thymomas-is-associated-with-low-perioperative-morbidity-and-mortality
#17
Candice L Wilshire, Eric Vallières, Dale Shultz, Ralph W Aye, Alexander S Farivar, Brian E Louie
OBJECTIVE: The approach to thymoma resection has usually been determined by tumor size, although established guidelines do not exist. Minimally invasive approaches have been limited to tumors smaller than 5 cm, although 3 cm has been the suggested cutoff for performing an adequate oncologic procedure. No study has compared the perioperative outcomes of patients with 3 cm or larger tumors resected robotically versus sternotomy. METHODS: We reviewed patients who underwent resection of 3 cm or larger thymomas from 2004 to 2014...
September 2016: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
https://www.readbyqxmd.com/read/27607762/ascending-aortic-endoballoon-occlusion-feasible-despite-moderately-enlarged-aorta-to-facilitate-robotic-mitral-valve-surgery
#18
Sarah L Breves, Inki Hong, James McCarthy, Mohammed Kashem, G William Moser, Thomas M Kelley, Erin E Mills, Grayson H Wheatley, T Sloane Guy
OBJECTIVE: Aortic occlusion with an endoballoon is a well-established technique to facilitate robotic and minimally invasive mitral valve surgery. Use of the endoballoon has several relative contraindications including ascending aortic dilatation greater than 38 mm in size. We sought to review our experience using the endoballoon in cases of totally endoscopic mitral valve surgery with aortic diameters greater than 38 mm. METHODS: A retrospective review of our single-site database was conducted to identify patients undergoing totally endoscopic mitral valve surgery by a single surgeon using an endoballoon and who had ascending aortic dilation...
September 2016: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
https://www.readbyqxmd.com/read/27561176/prosthetic-aortic-valve-fixation-study-48-replacement-valves-analyzed-using-digital-pressure-mapping
#19
Candice Y Lee, Joshua K Wong, Ronald E Ross, David C Liu, Kamal R Khabbaz, Angelo J Martellaro, Heather R Gorea, Jude S Sauer, Peter A Knight
OBJECTIVE: Prostheses attachment is critical in aortic valve replacement surgery, yet reliable prosthetic security remains a challenge. Accurate techniques to analyze prosthetic fixation pressures may enable the use of fewer sutures while reducing the risk of paravalvular leaks (PVL). METHODS: Customized digital thin film pressure transducers were sutured between aortic annulus models and 21-mm bioprosthetic valves with 15 × 4-mm, 12 × 4-mm, or 9 × 6-mm-wide pledgeted mattress sutures...
September 2016: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
https://www.readbyqxmd.com/read/27662478/minimally-invasive-mitral-valve-surgery-iii-training-and-robotic-assisted-approaches
#20
Eric J Lehr, T Sloane Guy, Robert L Smith, Eugene A Grossi, Richard J Shemin, Evelio Rodriguez, Gorav Ailawadi, Arvind K Agnihotri, Trevor M Fayers, W Clark Hargrove, Brian W Hummel, Junaid H Khan, S Chris Malaisrie, John R Mehall, Douglas A Murphy, William H Ryan, Arash Salemi, Romualdo J Segurola, J Michael Smith, J Alan Wolfe, Paul W Weldner, Glenn R Barnhart, Scott M Goldman, Clifton T P Lewis
Minimally invasive mitral valve operations are increasingly common in the United States, but robotic-assisted approaches have not been widely adopted for a variety of reasons. This expert opinion reviews the state of the art and defines best practices, training, and techniques for developing a successful robotics program.
July 2016: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
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