Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Feb 2009
Comparative StudyUse of steel bands in sternotomy closure: implications in high-risk cardiac surgical population.
A retrospective-prospective descriptive and comparative study of two sternal closure techniques in a population of 621 patients divided into: group A, steel band closure (n=300) and group B, conventional technique closure (n=321), was carried out between January 2005 and December 2007 in order to describe and compare the results of both techniques in high-risk patients for sternal dehiscence and mediastinitis. Differences between both groups and association with risk factors were obtained using non-parametric tests for statistical analysis. No complications or mortality related to the use of the steel sternal bands were found. ⋯ Sternal dehiscence was found to be a risk factor for mediastinitis. This study demonstrates that the use of steel bands for median sternotomy closure is a safe, reliable and reproducible technique. The frequency of sternal dehiscence significantly decreases with this technique in high-risk patients.
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Interact Cardiovasc Thorac Surg · Feb 2009
Case ReportsEndovascular stent placement for acute type-B aortic dissection with malperfusion--an intentional surgical delay and a possible 'bridging therapy'.
Acute aortic dissection frequently causes life-threatening organ ischemia. The optimal therapy for acute type-B aortic dissection is still controversial. Early surgery for acute dissections with organ malperfusion is known to carry a high morbidity and mortality. ⋯ It immediately relieved the abdominal and lower limb ischemic symptoms. The advantage of small-sized stent placement is its easiness and being gentle to fragile intima. The small-sized stent placement for patients with acute aortic dissection with visceral organ ischemia may be a promising 'bridging therapy' before they undergo traditional central repair.
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Interact Cardiovasc Thorac Surg · Feb 2009
Case ReportsSurgical repair of coronary sinus atrial septal defect and supraventricular tachycardia.
A 67-year-old female had suffered from fatigue and palpitation. Cardiac examination revealed coronary sinus atrial septal defect, moderate mitral and tricuspid regurgitation, coronary artery disease, and supraventricular tachycardia with paroxysmal atrial fibrillation. Surgical repair of the anomaly, regurgitant valves, and arrhythmia associated with coronary revascularization was successfully performed and the patient has been doing well in normal sinus rhythm.
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Interact Cardiovasc Thorac Surg · Feb 2009
Sorin Bicarbon bileaflet valve: a 9.8-year experience. Clinical performance of the prosthesis after heart valve replacement in 587 patients.
To determine early and mid-term clinical performance of the Sorin Bicarbon bileaflet prosthesis. ⋯ Sorin Bicarbon prosthesis provides excellent clinical results and mid-term survival with very low complication rates comparable with those of other bileaflet prostheses currently in use.
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Interact Cardiovasc Thorac Surg · Feb 2009
Case ReportsIntraoperative retrograde type I aortic dissection in a patient with chronic type IIIb dissecting aneurysm.
Iatrogenic acute aortic dissection of the ascending aorta during cardiac surgery is a rare but potentially fatal complication. We describe the emergency repair of iatrogenic acute aortic dissection of the ascending aorta during distal arch replacement in a patient with a chronic type IIIb dissecting aneurysm. We scheduled distal arch and descending aortic aneurysm repair through a left anterolateral thoracotomy with a femoro-femoral bypass. ⋯ The patient recovered uneventfully after extensive surgical replacement of the thoracic aorta and remains asymptomatic at two years after the procedure. To prevent possible neurological complications, this patient was managed by selective antegrade cerebral perfusion at 31 degrees C because we could not afford to wait for the induction of deep hypothermia. Successful management of iatrogenic acute aortic dissection depends on immediate recognition and the appropriate choice of surgical repair.