European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
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Eur J Cardiothorac Surg · Oct 2011
Minimally invasive trans-mediastinal endoscopic approach to insert phrenic stimulation electrodes in the human diaphragm: a preliminary description in cadavers.
Diaphragm pacing by phrenic nerve (PN) stimulation is currently used for patients with central respiratory paralysis to be weaned from mechanical ventilation. Electrodes are inserted either through bilateral thoracotomy or through four ports laparoscopy. The aim of this experimental work is to demonstrate the feasibility of trans-mediastinal bilateral implantation of PN electrodes using a flexible gastroscope introduced through a cervical incision in human cadavers. ⋯ Trans-mediastinal implantation of PN stimulation electrodes is possible using a flexible endoscope. This application of endoscopic surgery could allow a minimally invasive placement of PN electrodes in patients with central respiratory paralysis, for example, at the time of tracheostomy.
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Eur J Cardiothorac Surg · Oct 2011
The aortic interleaflet triangles annuloplasty: a multidisciplinary appraisal.
Aortic interleaflets triangles annuloplasty (AITA) reduces interleaflet triangles' circumferential extent through properly placed sutures. To achieve aortic root functional unit (ARFU) stabilization, we aimed at quantifying the effect of suture extent (SE) on aortic valve function and at finding general optimization criteria. ⋯ So far, the AITA seems to be a valuable technique to increase leaflet CL in aortic valve repair and in silico models seem to be able to predict the principles of the phenomena but not the individual complexity.
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Eur J Cardiothorac Surg · Sep 2011
Conventional aortic valve replacement for high-risk aortic stenosis patients not suitable for trans-catheter aortic valve implantation: feasibility and outcome.
High-risk patients with aortic stenosis are increasingly referred to specialist multidisciplinary teams (MDTs) for consideration of trans-catheter aortic valve implantation (TAVI). A subgroup of these cases is unsuitable for TAVI, and high-risk conventional aortic valve replacement (AVR) is undertaken. We have studied our outcomes in this cohort. ⋯ MDT assessment of high-risk aortic stenosis in the era of TAVI has increased the number of referrals. Conventional open surgery remains a valid option for these patients, with acceptable in-hospital mortality and early/midterm outcomes but high in-hospital morbidity.