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https://www.readbyqxmd.com/read/28823011/guidelines-versus-reality-is-coronary-stent-application-in-three-vessel-disease-standard-or-the-exception
#1
Roland Linder, J Zeidler, F Verheyen, J-M Graf von der Schulenburg, A Haverich, T Schilling
The national guidelines for treatment of chronic coronary heart disease (CHD) recommend surgical coronary aortic bypass grafting (CABG) rather than percutaneous coronary intervention (PCI) for patients with a coronary three-vessel disease. The epidemiology of three-vessel CHD and data about the application of different revascularisation strategies raise suspicion of deviation from the guidelines in the treatment of those patients. Claims data containing records of almost 10 million patients of the largest German statutory health insurance fund (Techniker Krankenkasse) were utilised to measure adherence to the guidelines for treatment of groups of patients with one-, two-, and three-vessel CHD, respectively...
August 19, 2017: European Journal of Health Economics: HEPAC: Health Economics in Prevention and Care
https://www.readbyqxmd.com/read/28820544/use-of-adjuncts-reduces-cardiopulmonary-bypass-time-during-minimally-invasive-aortic-valve-replacement
#2
Alice Wang, Sharon L McCartney, Judson B Williams, Asvin Ganapathi, Donald D Glower, Alina Nicoara, Jeffrey G Gaca
BACKGROUND: Minimally invasive aortic valve replacement (MIAVR) through a mini-thoracotomy is comparable to AVR through a sternotomy, but may have increased surgical times. The development of adjuncts such as the automatic knot fastener and percutaneous coronary sinus (CS) catheter may reduce this disadvantage. METHODS: A retrospective review conducted between 2002 and 2015 at a single institution revealed 78 patients who underwent MIAVR with adjuncts. The automatic knot fastener was used on all patients, and a successful CS catheter was placed and confirmed by echocardiography in 67 patients (86%)...
March 2017: Journal of Heart Valve Disease
https://www.readbyqxmd.com/read/28810647/limb-graft-occlusion-following-endovascular-aortic-repair-incidence-causes-treatment-and-prevention-in-a-study-cohort
#3
Guoquan Wang, Shuiting Zhai, Tianxiao Li, Xuan Li, Danghui Lu, Bo Wang, Dongbin Zhang, Shuaitao Shi, Zhidong Zhang, Kai Liang, Kewei Zhang, Xiaoyang Fu, Kun Li, Weixiao Li
The present study investigated the incidence, causes, treatment and prevention of limb graft occlusion following endovascular aortic repair (EVAR). A total of 66 cases of abdominal aortic aneurysm receiving EVAR at our department from January 2005 to December 2013 were enrolled. After EVAR, patients received routine antiplatelet therapy of 75 mg PLAVIX for 6 months and then 100 mg Aspirin for another 6 months by oral administration. According to previous clinical experiences, antiplatelet therapy is able to effectively reduce the incidence of iliac occlusion after EVAR...
August 2017: Experimental and Therapeutic Medicine
https://www.readbyqxmd.com/read/28808651/evaluation-of-acute-aortic-dissection-type-a-factors-and-comparison-the-postoperative-clinical-outcomes-between-two-surgical-methods
#4
Hasan Shemirani, Amir Mirmohamadsadeghi, Behzad Mahaki, Sadaf Farhadi, Reza Mohseni Badalabadi, Peyman Bidram, Mehdi Mohseni Badalabadi
BACKGROUND: Although aortic dissection is a rare disease, it causes high level of mortality. If ascending aorta gets involved in this disease, it is known as type A. According to small number of studies about this disease in Iran, this study conducted to detect the factors related to acute aortic dissection type A, its surgery consequences and the factors affecting them. MATERIALS AND METHODS: In this historical cohort study, all patients having acute aortic dissection type A referring to Chamran Hospital from 2006 to 2012 were studied...
2017: Advanced Biomedical Research
https://www.readbyqxmd.com/read/28807407/infrarenal-aorta-as-the-donor-site-for-bypasses-to-the-superior-mesenteric-artery-for-chronic-mesenteric-ischemia-a-prospective-clinical-series-of-24-patients
#5
Giulio Illuminati, Giulia Pizzardi, Francesco G Calio', Rocco Pasqua, Federica Masci, Francesco Vietri
BACKGROUND: Treatment of symptomatic, chronic mesenteric ischemia is indicated to relieve symptoms and prevent acute ischemia and death. Current therapeutic options include endovascular and open surgery. The purpose of this prospective study was to evaluate the results of bypasses to the superior mesenteric artery arising from the infrarenal aorta or infrarenal aortic grafts. METHODS: From January 1999 to December 2016, 24 consecutive patients with a mean age of 61 years underwent a prosthetic bypass to the superior mesenteric artery...
August 11, 2017: Surgery
https://www.readbyqxmd.com/read/28806174/left-ventricular-apex-venting-in-high-risk-redo-sternotomy-with-severe-aortic-insufficiency-a-case-report
#6
Brett J Wakefield, Alexander J Leone, Shiva Sale
Redo cardiac surgery in patients with severe aortic insufficiency can present unique challenges to the anesthesiologist. We report a case highlighting the challenge and importance of interdisciplinary planning between cardiothoracic surgeons and anesthesiologists prior to high-risk surgery. Failure to place an endoaortic balloon and percutaneous coronary sinus catheter due to anatomical abnormalities prompted the adoption of an alternate technique involving apical ventricular venting to assist sternal reentry...
August 10, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/28803216/3d-2d-registration-with-superabundant-vessel-reconstruction-for-cardiac-resynchronization-therapy
#7
Daniel Toth, Maria Panayiotou, Alexander Brost, Jonathan M Behar, Christopher A Rinaldi, Kawal S Rhode, Peter Mountney
A key component of image guided interventions is the registration of preoperative and intraoperative images. Classical registration approaches rely on cross-modality information; however, in modalities such as MRI and X-ray there may not be sufficient cross-modality information. This paper proposes a fundamentally different registration approach which uses adjacent anatomical structures with superabundant vessel reconstruction and dynamic outlier rejection. In the targeted clinical scenario of cardiac resynchronization therapy (CRT) delivery, preoperative, non contrast-enhanced, MRI is registered to intraoperative, contrasted X-ray fluoroscopy...
August 5, 2017: Medical Image Analysis
https://www.readbyqxmd.com/read/28800983/gastrointestinal-complications-after-cardiac-surgery-a-nationwide-population-based-analysis-of-morbidity-and-mortality-predictors
#8
Rabail Chaudhry, John Zaki, Robert Wegner, Greesha Pednekar, Alex Tse, Roy Sheinbaum, George W Williams
OBJECTIVE: The authors aimed to evaluate the incidence, risk factors, and outcomes of gastrointestinal (GI) complications in cardiac and aortic surgery using recent versions of the National (Nationwide) Inpatient Sample (NIS) to provide clinicians with a better understanding of these uncommon but potentially serious complications. DESIGN: Population-based study. SETTING: NIS database 2010-2012. PARTICIPANTS: Patients undergoing cardiac and aortic aneurysm repair surgeries...
August 2017: Journal of Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/28797584/long-term-outcomes-of-frozen-elephant-trunk-for-type-a-aortic-dissection-in-patients-with-marfan-syndrome
#9
Wei-Guo Ma, Wei Zhang, Jun-Ming Zhu, Bulat A Ziganshin, Ai-Hua Zhi, Jun Zheng, Yong-Min Liu, John A Elefteriades, Li-Zhong Sun
OBJECTIVE: The use of the frozen elephant trunk (FET) technique for repair of type A aortic dissection (TAAD) in Marfan syndrome (MFS) is controversial. We seek to evaluate the efficacy of FET and total arch replacement (TAR) for TAAD in patients with MFS. METHODS: The early and long-term outcomes were analyzed for 106 patients with MFS (mean age, 34.5 ± 9.7 years) undergoing FET + TAR for TAAD. RESULTS: Operative mortality was 6.6% (7 of 106)...
June 16, 2017: Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/28795891/experience-using-closed-incision-negative-pressure-wound-therapy-in-sternotomy-patients
#10
B Philip, P McCluskey, J Hinchion
OBJECTIVE: Postoperative delayed wound healing, surgical site infections (SSIs), and other wound complications are associated with increased morbidity and health-care costs. In cardiothoracic surgery, wound complications can have life-threatening consequences. In recent years, negative pressure wound therapy (NPWT) has been applied over closed surgical incisions to help reduce tension and protect from external contamination. We report our initial experiences using a closed incision negative pressure therapy (ciNPT) over clean, closed sternotomy incisions at an Irish tertiary referral centre...
August 2, 2017: Journal of Wound Care
https://www.readbyqxmd.com/read/28795032/extra-anatomic-ascending-aorta-to-abdominal-aorta-bypass-in-takayasu-arteritis-patients-with-mid-aortic-syndrome
#11
Hak Ju Kim, Jae-Woong Choi, Ho Young Hwang, Hyuk Ahn
BACKGROUND: We evaluated the operative outcomes of an extra-anatomic bypass from the ascending aorta to the abdominal aorta in patients with type II or III Takayasu arteritis (TA) with mid-aortic syndrome. METHODS: From 1988 to 2014, 8 patients with type II (n=2) or III (n=6) TA underwent an ascending aorta to abdominal aorta bypass. The mean patient age was 43.5±12.2 years and the mean peak pressure gradient between the upper and lower extremities was 54.8±39...
August 2017: Korean Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/28794053/low-flow-severe-aortic-stenosis-evolving-role-of-transcatheter-aortic-valve-replacement
#12
REVIEW
Matthew D Saybolt, Paul N Fiorilli, Zachary M Gertz, Howard C Herrmann
The definition of severe aortic stenosis has classically and retrospectively been based on the natural history of patients with medically managed aortic stenosis and preserved left ventricular function in an era where surgical aortic valve replacement was the sole therapy. We now recognize that this disease is more heterogeneous and includes important subsets of patients with low stroke volume index (low flow) and low-gradient with reduced (classical) or preserved (paradoxical) ejection fraction. These patients pose diagnostic and treatment dilemmas, requiring a comprehensive assessment with integration of multimodality imaging, testing, and clinical assessment...
August 2017: Circulation. Cardiovascular Interventions
https://www.readbyqxmd.com/read/28793902/30-year-experience-of-fontan-surgery-single-centre-s-data
#13
Laurynas Bezuska, Virgilijus Lebetkevicius, Rita Sudikiene, Daina Liekiene, Virgilijus Tarutis
BACKGROUND: The Fontan procedure has been modified several times since it was introduced into practice in 1968. As many patients now survive to adulthood, attention is directed towards their clinical status and late morbidity. We report our surgical experience of 30 years in Fontan procedures. METHODS: From January 1985 to January 2015, 80 patients underwent Fontan surgery. Twenty-one patients received an atrio-pulmonary Fontan (Group I), four patients underwent total cavopulmonary connection (TCPC) with an intra-atrial lateral tunnel (Group II), six patients received extra-cardiac TCPC with an aortic homograft (group III) and 49 patients received extra-cardiac TCPC with an expanded polytetrafluoroethylene conduit...
August 9, 2017: Journal of Cardiothoracic Surgery
https://www.readbyqxmd.com/read/28790276/-acute-leg-ischemia-at-acute-aortic-dissection
#14
Yukio Kuniyoshi
Legs ischemia might be associated with acute aortic dissection, in acute phase or even in subacute phase. In general, immediate central repair for acute aortic dissection is mandatory prior to intervention of leg ischemia because central repair might improve leg ischemia. Depending on condition of leg ischemia, revascularization of occluded artery should be considered. The perfusion to ischemic leg during central repair is useful to diminish leg injury. There are some useful modalities for revascularization such as some route of extra-anatomical bypass, placing of stent graft for closing entry site of dissected aortic wall...
July 2017: Kyobu Geka. the Japanese Journal of Thoracic Surgery
https://www.readbyqxmd.com/read/28790269/-brain-protection-for-shaggy-aorta-during-aortic-arch-surgery
#15
Kenji Okada
Although short and long-term outcomes of aortic surgeries have been improving over the past decade, the procedure is likely to be asscociated with life-threatening complications such as neurological deficits caused by suboptimal brain protection or heavily diseased aorta. Contemporary strategies for brain protection are deep hypothermic arrest with or without retrograde cerebral perfusion retrograde cerebral perfusion or selective antegrade cerebral perfusion. At the moment, majority of evidences failed to show the superiority of selective antegrade cerebral perfusion to retrograde one...
July 2017: Kyobu Geka. the Japanese Journal of Thoracic Surgery
https://www.readbyqxmd.com/read/28790268/-perioperative-care-of-low-cardiac-output-syndrome
#16
Hiroki Kato, Yoshiro Matsui
Low cardiac syndrome( LOS) is the imbalance of the oxygen supply and demand at the tissue due to reduced oxygen supply by decreased cardiac function. The causes of the cardiac dysfunction are insufficient cardioplegia, elongation of aortic clamp or cardiopulmonary bypass (CPB) duration, incomplete revascularization, and so on. The preventions of LOS are myocardial protections intraoperatively. The most important myocardial protection is to accomplish more quickly, accurately and safety to operation. And today, cardioplegia is essential for surgery requiring CPB...
July 2017: Kyobu Geka. the Japanese Journal of Thoracic Surgery
https://www.readbyqxmd.com/read/28790239/-left-subclavian-artery-occlusion-by-using-amplatzer-vascular-plug-i-during-thoracic-endovascular-repair
#17
Akihisa Furuta, Masaaki Koide, Yoshifumi Kunii, Takuya Maeda
OBJECTIVE: The purpose of this study is to report the use of Amplatzer Vascular Plug (AVP) I for left subclavian artery (LSCA) occlusion during thoracic endovascular repair (TEVAR) with extra-anatomical bypass. METHODS: Retrospective review was undertaken in twelve patients who underwent transcatheter occlusion of the LSCA with AVP I as a part of TEVAR of thoracic aneurysm and aortic dissection at a single institution between Feb. 2014 and Jul. 2015. RESULT: Mean age was 72...
August 2017: Kyobu Geka. the Japanese Journal of Thoracic Surgery
https://www.readbyqxmd.com/read/28790028/staged-retroperitoneal-mesenteric-revascularisation-and-aortobifemoral-bypass-after-endovascular-rescue-for-acute-mesenteric-ischaemia
#18
Shepard Peir Johnson, Melani Lighter, Harry Linne Anderson, Abdulhameed Aziz
Visceral artery revascularisation through a retroperitoneal approach provides an infrequent yet viable, alternative means of managing mesenteric ischaemia in patients with previous abdominal operations. We present a unique case implementing this surgical approach in a 55-year-old man in which we performed a retroperitoneal aortobifemoral bypass with concomitant retrograde jump graft from the aortic prosthesis to the superior mesenteric artery (SMA) for bilateral lower extremity rest pain and chronic mesenteric ischaemia...
August 8, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/28789610/management-of-refractory-bleeding-post-cardiopulmonary-bypass-in-an-acute-heparin-induced-thrombocytopenia-type-ii-renal-failure-patient-who-underwent-urgent-cardiac-surgery-with-bivalirudin-angiox-%C3%A2-anticoagulation
#19
Kimberly Hassen, Maria R Maccaroni, Haytham Sabry, Smitangshu Mukherjee, Shankari Serumadar, Inderpaul Birdi
Acute heparin-induced thrombocytopenia (HIT) patients present a myriad of anticoagulation management challenges, in clinical settings where unfractionated heparin (UFH) is the traditional drug of choice. UFH use in cardiac surgery is a known entity that has been subject to rigorous research. Research has, thus, led to its unparalleled use and the development of well-established protocols for cardiac surgery. In comparison to UFH, bivalirudin use for acute HIT patients requiring urgent cardiac surgery with cardiopulmonary bypass (CPB) is still in its infancy...
August 1, 2017: Perfusion
https://www.readbyqxmd.com/read/28781880/acute-aortic-occlusion-due-to-tumor-embolism-in-a-patient-with-lung-malignancy
#20
Stella Lioudaki, Nikolaos Kontopodis, Stefanos Palioudakis, Anastasios V Koutsopoulos, Ioannis Drositis, Christos V Ioannou
OBJECTIVES: Acute lower limb ischemia caused by tumor embolization is rare, despite the fact that cancer is a common cause of hypercoagulability predisposing to venous thrombosis. Arterial embolization is mostly associated with intracardiac tumors while lung malignancies are the second most common cause of tumor embolism. METHODS: In this report, we present a male patient who developed acute bilateral lower limb ischemia in the immediate postoperative period after a thoracotomy for attempted left upper lobe resection for lung cancer...
2017: SAGE open medical case reports
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