Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Jun 2015
Is minimally invasive mitral valve repair with artificial chords reproducible and applicable in routine surgery?
Traditional resectional techniques and chordal transfer are difficult to apply in video-assisted mitral valve repair. Using artificial chords appears easier in this setting. The purpose of this study was to review the effectiveness and reproducibility of neochordal repair as a routine approach to minimally invasive mitral repair, and to assess the stability of neochord implantation using the figure-of-eight suture without pledgets in this setting. ⋯ Minimally invasive mitral valve repair using neochords provided a high rate of repair, reproducible results in a routine cardiac surgery setting and stable repair during follow-up. This has become our preferred technique for mitral valve surgery.
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Interact Cardiovasc Thorac Surg · May 2015
Technical and anatomical factors affecting the size of the branch pulmonary arteries following first-stage Norwood palliation for hypoplastic left heart syndrome.
Branch pulmonary artery (BPA) size is one of the factors that influence the efficacy of the Fontan circulation. Central pulmonary artery stenosis and small left pulmonary artery (LPA) are well-known problems following Norwood palliation for hypoplastic left heart syndrome (HLHS). We investigated anatomical and technical factors that may stand behind these problems. ⋯ Of all studied factors, IAR and the size and position of the pulmonary artery bifurcation plays the main role in LPA growth and central BPA stenosis.
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Interact Cardiovasc Thorac Surg · May 2015
Case ReportsEmergency surgical extraction of rota ablator from the stent in the left anterior descending artery.
Trapping of interventional devices used to treat in-stent restenosis is rarely reported in the literature. Among those is a trapped rota ablation wire causing longitudinal stent deformation, sometime requiring another stent deployment onto the collapse stent. ⋯ During the procedure, the rota ablator got stuck into the stent resulting in haemodynamic compromise. To our knowledge, this is the first case where a rota ablator got stuck into the stent requiring surgical intervention.
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Interact Cardiovasc Thorac Surg · May 2015
Comparative StudyAortic valve reimplantation for large root aneurysm and high-grade aortic regurgitation: incidence and implications of additional cusp and commissure repair.
Large-sized root aneurysm and high-grade aortic regurgitation (AR) might be contraindications for a valve-sparing aortic root replacement procedure (V-SARR) and aortic valve repair. The impact of a combination of root reimplantation and additional cusp/commissure repair on valve sufficiency in this setting was investigated with respect to early- and mid-term functional outcome. ⋯ The setting of a large proximal thoracic aortic aneurysm size and high-grade AR does not result in a higher need for cusp/commissure procedures in order to achieve a satisfactory mid-term functional outcome. Large aneurysm size and high-grade AR per se do not increase the complexity of repair. The choice of reimplantation technique and prosthesis size selection might impact on mid-term valve function.
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Interact Cardiovasc Thorac Surg · May 2015
Review Case Reports Comparative StudyDoes a skeletonized internal thoracic artery give fewer postoperative complications than a pedicled artery for patients undergoing coronary artery bypass grafting?
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was 'Does a skeletonized internal thoracic artery (ITA) give fewer postoperative complications than a pedicled artery for patients undergoing coronary artery bypass grafting?' Altogether, 98 papers were found using the reported search, of which 11 represented the best evidence to answer the clinical question. Papers about patency of skeletonized versus pedicled internal thoracic artery were excluded. ⋯ The hospital stay was shorter for three studies conducted on this subject. One study about pulmonary function reported a better ratio of pre- versus postoperative values of forced vital capacity. Despite longer operating times, skeletonization leads to fewer wound infections, reduced chest pain, allows a shorter hospital stay and better preserves pulmonary function.