Biomedical subjects

Anton Moritz

Publications and source records attributed to Anton Moritz.

At least 19 recordsLinked to original sources

PubMed2006

Left ventricular remodeling impacts the function of the Quattro stentless mitral valve bioprosthesis (a 4-year experience).

OBJECTIVE: The St Jude Quattro stentless mitral valve prosthesis (QMV) is sutured to the mitral annulus and the papillary muscle heads, thereby preserving the subvalvular apparatus. After mitral valve replacement, remodeling of the left ventricle is often observed, causing a dilated ventricle to shrink in diameter. It was our objective to assess these changes in left ventricular (LV) geometry and evaluate its effects on the function of the QMV. METHODS: From September 1997 to October 2000, 24 patients received QMV at our institution. The patients were followed up at yearly intervals (mean 4.1 +/- 2.2 years). All pre- and postoperative echocardiograms were evaluated, with attention focused on the subvalvular apparatus, leaflet morphology, and occurrence of late mitral regurgitation. In addition, all clinical outcomes and valve-related complications were recorded. RESULTS: Forty-one percent of patients (10/24) developed late mitral regurgitation (mild, n = 5; moderate, n = 5). The site of regurgitation was located at the 2 commissures in all cases. In 8 patients, changes in LV diameter had occurred. The point of leaflet coaptation had shifted away from the annulus in 4 patients. The overall mortality was 12.3%, and the postoperative stroke rate was 12.3%. CONCLUSIONS: Midterm changes in LV geometry seem to affect the competence of the QMV. Predicting these changes and subsequently adapting the sizing procedure remain a challenging task. The high rate of late valve incompetence and poor clinical outcomes has prompted us to discontinue recruitment of patients for this trial.

Bioprosthesis↗

PubMed2006

Two hundred forty minimally invasive mitral operations through right minithoracotomy.

BACKGROUND: This study reports of our 7-year experience with minimally invasive mitral valve operations using the transthoracic clamp technique, reviewing morbidity and mortality as well as echocardiographic follow-up results. METHODS: Between 1997 and 2004, 241 patients (121 male; aged 56 +/- 14 years) underwent minimally invasive mitral valve surgery through right thoracotomy using the transthoracic clamp technique. Reconstructions were done in 199 patients, and 42 valves were replaced. Mean length of incision was 7.0 +/- 1.2 cm. Mean preoperative New York Heart Association functional class was 2.6 +/- 0.9. RESULTS: Thirty-day mortality was 3.3% (n = 8). Operating, bypass, and cross-clamp times averaged 241 +/- 52, 142 +/- 40, and 84 +/- 26 minutes, respectively. Seven patients (2.9%) had conversion to sternotomy. Nine patients (3.7%) underwent reexploration for bleeding. Mean intensive care unit and hospital stay were 18 hours and 8.1 days, respectively. Mean follow-up was 30 +/- 18 months (range, 3 to 76). Echocardiographic follow-up documented persistently competent valve function in all but 6 patients who had grade III regurgitation. Five of them underwent mitral valve re-reconstruction and 1 underwent transplantation. At 76 months, freedom from nontrivial recurrent mitral regurgitation and reoperation were 92.3% and 96.2%, respectively. Actuarial survival at 76 months, including early mortality, was 90.7%. Thoracic wounds were free from infection in all patients. CONCLUSIONS: This study demonstrates that the direct vision, transthoracic clamp technique for minimally invasive mitral valve surgery is reproducible with low mortality and morbidity rates. It results in excellent cosmesis and abolished the risk of thoracic wound infection. Results are comparable to midterm outcomes of conventional operations.

Adolescent↗

PubMed2006

Seven years' experience with suture annuloplasty for mitral valve repair.

OBJECTIVE: Our early experience with the mural annulus shortening suture procedure for mitral valve repair showed superior hemodynamic performance over ring annuloplasty. The aim of this study was to assess the durability of the mural annulus shortening suture procedure and evaluate our 7-year experience regarding valve function, hemodynamic performance, and clinical outcome. METHODS: Between 1996 and 2003, 222 elective consecutive patients (58.1% males; age, 59 +/- 14 years) underwent simple or complex mitral valve repair. Minimal invasive reconstruction was performed in 150 patients. For correction of annular dilatation, we used double-running 2-0 polytetrafluoroethylene sutures to reinforce the posterior circumference of the annulus. Patients were investigated prospectively by means of transthoracic echocardiography before discharge and 1 and 5 years after the operation. The mean follow up was 32 +/- 21 months (range 1-77 months). RESULTS: The operative mortality was 3.1%. Hemodynamic performance at 1 and 5 years showed low mean transvalvular gradients (2.1 +/- 0.9 and 2.0 +/- 0.8 mm Hg, respectively) and a calculated mitral valve orifice area of 3.3 +/- 0.9 cm2 and 3.1 +/- 0.6 cm2, respectively, with progressive annular dilatation from 31.2 +/- 3 mm to 33.9 +/- 4 mm at 1 year and 35.7 +/- 4 mm at 5 years (P < .01). Clinical status improved from New York Heart Association class 3.0 +/- 0.4 to 0.6 +/- 0.8 at 1 year and 0.8 +/- 0.8 at 5 years. Freedom form nontrivial residual mitral regurgitation was 82.3%, freedom from reoperation was 95.1% and actuarial survival was 87.2%, all at 77 months. CONCLUSIONS: The midterm results show satisfactory hemodynamic performance and clinical improvement. Valve competence and reoperation rates are comparable with those of other reports. Durability of the mural annulus shortening suture procedure for mitral valve repair is questioned because progressive annular redilatation occurs.

Female↗

PubMed2006

Stentless bioprostheses improve postoperative coronary flow more than stented prostheses after valve replacement for aortic stenosis.

OBJECTIVE: In some randomized studies, stentless aortic valves have demonstrated hemodynamic advantages in comparison with stented prostheses. The effect of more physiologic flow dynamics on coronary artery flow has not been investigated yet. This study compares coronary perfusion after aortic valve replacement with stented or stentless porcine bioprostheses in a prospective randomized study. METHODS: A total of 24 patients (73 +/- 6 years) referred for treatment of aortic stenosis were randomized to aortic valve replacement with stented (Medtronic Mosaic; (Medtronic Inc, Minneapolis, Minn) or stentless (Medtronic Freestyle; Medtronic Inc) prostheses. Coronary flow was measured by means of magnetic resonance imaging preoperatively, 5 days after the operation, and 6 months postoperatively, then with evaluation of coronary flow reserve. Echocardiography was performed to quantify transvalvular gradients and left ventricular mass regression. RESULTS: Coronary flow increased in both groups significantly (P < .001) after aortic valve replacement. This increase was higher in the stentless group compared with that seen in the stented group (343 +/- 137 vs 221 +/- 66 mL/min). Also, coronary flow reserve was higher for stentless valves (3.4 +/- 0.3 for stentless valves and 2.3 +/- 0.1 for stented valves). Mean pressure gradients for Freestyle valves were lower (10 +/- 4 and 8 +/- 3 mm Hg, respectively, vs 19 +/- 6 postoperatively and 15 +/- 4 mm Hg at follow-up for Mosaic valves, P < .05). Left ventricular mass regression was similar in both groups. CONCLUSIONS: Normalization of coronary artery flow after aortic valve replacement for aortic stenosis was more pronounced for stentless valves compared with stented valves. The fact that the stentless design also demonstrated a superior hemodynamic performance with lower pressure gradients might be explained by the design being closer to physiologic anatomy and thus the presence of lower turbulence levels in the sinuses of Valsalva.

Aged↗

PubMed2006

The use of minimized extracorporeal circulation system has a beneficial effect on hemostasis--a randomized clinical study.

BACKGROUND: Conventional cardiopulmonary bypass (CPB) is associated with increased coagulation and fibrinolytic activity. A closed miniaturized bypass circuit (CorX) features a significantly reduced tubing set, an integrated pump, and an air removal system without a cardiotomy reservoir. In a prospective randomized trial, the effects on hemostasis were investigated while comparing CorX with conventional CPB in patients undergoing coronary artery bypass grafting. METHODS: Over a period of 1 year, 81 patients were randomly assigned either to the CorX system (n = 39, group A) or standard CPB system (n = 42, group B). Primary endpoints were platelet count, plasmin-antiplasmin complex (PAP), prothrombin fragments 1+2 (F1+F2), D-dimers, and fibrinogen. Secondary end-points were hematocrit, blood loss in the first 12 hours postoperatively, transfused packed red blood cells, and fresh frozen plasma in the first 24 hours postoperatively. In addition, we analyzed partial thromboplastin time, prothrombin time, and antithrombin III. RESULTS: After aortic declamping, PAP complex and prothrombin F1+F2 were significantly lower in group A than in group B. The difference in D-dimers between groups reached significance at 1 hour post-CPB. Hematocrit values at the end of CPB measured 26 +/- 6% in group A versus 22 +/- 4% in group B (P = .01). The rest of the observed parameters did not significantly differ between groups. CONCLUSION: Postoperative blood loss was not reduced in the present study. However, the use of the CorX system leads to a significant suppression of activation of coagulation and fibrinolytic cascades compared to conventional CPB, suggesting that miniaturized extracorporeal circuits are a step forward toward reduced imbalance of hemostasis in cardiac surgery.

Aged↗

PubMed2006

Impact of mechanical and biological aortic valve replacement on coronary perfusion: a prospective, randomized study.

BACKGROUND AND AIM OF THE STUDY: Coronary perfusion is impaired in patients with aortic stenosis (AS). Aortic valve replacement (AVR) leads to improvement, but not complete restoration, of coronary flow. Previous studies have shown that postoperative coronary flow rate and coronary reserve in mechanical valves is dependent on valve design and orientation. The study aim was to investigate acute changes in coronary perfusion in patients undergoing mechanical or biological valve replacement in a prospective, randomized clinical study. METHODS: Forty patients undergoing AVR for AS underwent MRI scanning to measure coronary flow preoperatively and at five days after surgery. Patients scheduled for mechanical AVR (n = 20) were randomized to a tilting disc (Medtronic Hall) or bileaflet (Medtronic ADVANTAGE) prosthesis; the biological-valve group (n = 20) received a stented (Medtronic Mosaic) or stentless (Medtronic Freestyle) valve. Valve sizes were comparable in all groups. Patients also underwent echocardiography both preoperatively and postoperatively to measure transvalvular pressure gradients. The rate-pressure product (RPP) was calculated as a marker of myocardial oxygen demand and cardiac workload. RESULTS: The mean preoperative coronary flow rate was 90 +/- 32 ml/min, and this increased after AVR in all patients. The rise in the mechanical-valve groups was comparable for the two tested valves, whereas in the biological-valve groups a significantly higher increase for stentless valves was present (p < 0.05). Mean pressure gradients for the Hall and ADVANTAGE valves were equal; for biological valves, the Mosaic demonstrated a higher mean gradient (19 +/- 6 mmHg) than the Freestyle (10 +/- 4 mmHg) (p < 0.05). The RPP was lower for ADVANTAGE (mechanical group) and for Freestyle valves (biological group). CONCLUSION: Coronary artery flow was increased following AVR in all valve groups. The rise was significantly more distinct for Medtronic Freestyle stentless valves compared to the three other valve substitutes. As the stentless design also demonstrated superior hemodynamics and a lower myocardial oxygen demand with lower pressure gradients and lower RPP, this may have a positive impact on the clinical long-term outcome of this valve.

Age Factors↗

PubMed2006

Annular compression stitch for quadrangular resections in mitral valve repair.

BACKGROUND AND AIM OF THE STUDY: Quadrangular resections for posterior mitral leaflet prolapse create a defect that requires readaptation of the annulus as well as the leaflet cut edges. A variety of techniques has been described to narrow the posterior mitral annulus. Herein is described a simple compression stitch that allows compensation of annular size reduction even for large resections of the mural leaflet. METHODS: The annular compression stitch consists of four bites: the first stitch is placed from the atrium into the ventricle; the second takes a piece of ventricular myocardium parallel to the mitral ring; the third returns the needle into the atrium some millimeters outside the opposite cut edge of the mitral leaflet; and the fourth stitch grabs atrial myocardium parallel to the previous ventricular stitch. Tying the knots compresses the annulus to an extent that allows reanastomosis of the two leaflet cut edges. RESULTS: This new technique was used in 212 patients undergoing mitral valve repair. Intraoperative outcome was excellent, and after a mean follow up period of 2.5 years no reoperation was needed due to failure of the annular compression stitch. CONCLUSION: The new compression stitch simplifies the repair, avoids the creation of a trench, and allows readaptation of the two mural leaflet edges without tension, even in large posterior resections.

Cardiac Surgical Procedures↗

PubMed2005

Disseminated Aspergillus fumigatus infection with consecutive mitral valve endocarditis in a lung transplant recipient.

Aspergillus infection is a known complication of lung transplantation and remains associated with high mortality rates. The manifestation of the infection varies from simple colonization of the lung to disseminated complicated infections. Early Aspergillus infection has been rarely observed in a small number of lung transplant recipients; most cases occur during the late post-operative period. The pulmonary involvement has often been described as the first clinical localization of the disease. Although other various forms of Aspergillus infection are not uncommonly encountered after lung transplantation, Aspergillus mitral valve endocarditis is rare. We present a case of disseminated Aspergillus fumigatus infection with consecutive mitral valve endocarditis having developed 78 days after double-lung transplantation for cystic fibrosis.

Adult↗

PubMed2005

Degradation of microvascular brain endothelial cell beta-catenin after co-culture with activated neutrophils from patients undergoing cardiac surgery with prolonged cardiopulmonary bypass.

The adhesion of highly activated neutrophils to cerebral microvascular endothelial cells (MVECs) may contribute to disruption and hyperpermeability of the blood-brain barrier (BBB) after cardiac surgery with prolonged cardiopulmonary bypass (CPB). A correlation between CPB duration and neutrophil-mediated BBB damage has not been investigated on the cellular level yet. Therefore, we studied the effects of neutrophils from cardiac surgery patients with CPB time <80 min (group I; n=8) and >80 min (group II; n=8) on the integrity of cultured porcine MVEC. Ex vivo, neutrophils of group II but not of group I significantly degraded the zonula adherens molecule beta-catenin whereas VE-cadherin and occludin were not modified. The transendothelial electric resistance as a measure for the integrity of the endothelial monolayers was reduced over time in both groups. In conclusion, prolonged CPB time entails neutrophil-mediated decrease in MVEC beta-catenin expression, and thus may be an important trigger for BBB disruption.

Animals↗

PubMed2005

Echocardiographic assessment in minimally invasive mitral valve surgery.

BACKGROUND: Due to limited exposure, removal of intracavitary air and visual assessment of cardiac function during minimally invasive procedures are not always possible. We analysed the utility of intraoperative transesophageal echocardiography (TEE) and postoperative transthoracic echocardiographic (TTE) in minimally invasive mitral valve (MV) procedures. MATERIAL/METHODS: We evaluated data from 163 consecutive patients undergoing isolated minimally invasive MV replacement (n=40) or repair (n=123) via small right anterolateral thoracotomy (121 complex mitral procedures). Cardioplegic arrest was achieved using either endoaortic (n=23) or transthoracic aortic clamp (n=140). In addition to preoperative TTE, TEE was used intraoperatively before and after cardiopulmonary bypass (CPB). Postoperative TTE was performed to monitor valve function at 3 and 12 months, and at 5-year follow-up. RESULTS: Pre-CPB TEE was useful to assess valve dysfunction and assist in placement of the arterial and venous cannulas. During CPB, placement and positioning of the endoclamp were guided effectively in all but 4 patients, in whom recurrent balloon migration necessitated secondary transthoracic aortic clamping. TEE detected one acute retrograde aortic dissection and one circumflex artery occlusion. After 18.7+/-10.6 months follow-up, all patients except three improved symptomatically and had consistently good valve function. CONCLUSIONS: Intraoperative TEE is essential for minimally invasive MV surgery, because it allows immediate control of valve function before and after surgery. It is useful to detect unexpected complications requiring immediate remedy. Postoperative echocardiographic results show that minimally invasive MV surgery is a good alternative to conventional surgery even in complex MV repairs.

Adolescent↗

PubMed2005

Aortic leaflet replacement with the new 3F stentless aortic bioprosthesis.

PURPOSE: Clinical trials with the new 3F stentless aortic bioprosthesis began October 2001, and as one of the first centers to implant this prosthesis in humans, we would like to present our experiences with this new device. DESCRIPTION: The 3F aortic bioprosthesis is a stentless biological heart valve fabricated from three equal leaflets of equine pericardium, assembled in a tubular shape, and implanted in the native aortic root to replace the patient's diseased aortic leaflets. Between January 2002 and August 2002, 24 3F aortic bioprostheses were implanted at our institution. Effective orifice area, mean gradients, and ejection fraction were evaluated by echocardiography at discharge and at 12-month follow-ups after surgery. EVALUATION: At 12-month follow-ups, the 3F bioprosthesis showed a good hemodynamic performance with a significant drop of mean gradients to 10.3 mm Hg, a mean effective orifice area of 1.7 cm2, and a mean ejection fraction of 61.5%. CONCLUSIONS: The clinical performance of the new 3F aortic bioprosthesis is comparable with regular stentless aortic valves. However its unique design facilitates implantation.

Adult↗

PubMed2005

Pericardial patch augmentation for reconstruction of incompetent bicuspid aortic valves.

PURPOSE: Reoperation rates after repair of bicuspid aortic valves are higher than for mitral valve reconstruction. Secondary changes and small coaptation surface render repair unreliable. Satisfactory results have been reported for patch augmentation for tricuspid aortic valves. We have applied this technique for the repair of bicuspid aortic valves. DESCRIPTION: Our technique retains the bicuspid morphology of the incompetent aortic valve. A strip of glutaraldehyde-fixed pericardium is sutured to the free edge of the fused leaflet. A large coaptation surface is created, and competence of the bicuspid valve is achieved. EVALUATION: Sixteen patients underwent reconstruction of their bicuspid aortic valves by pericardial patch augmentation. There were no intraoperative or postoperative deaths. The degree of aortic regurgitation was none to trivial for all patients at a mean follow-up of 3.1 +/- 3.4 months. Planimetric effective orifice areas ranged above 2 cm2. Mean aortic gradients were 8.2 +/- 4.8 mm Hg, and the mean height of coaptation surface was 14.7 +/- 2.1 mm. CONCLUSIONS: The pericardial patch augmentation technique increases coaptation surface, and thus provides reliable early competence of reconstructed bicuspid aortic valves.

Adult↗

PubMed2005

Minimally invasive port access versus conventional mitral valve surgery: prospective randomized study.

BACKGROUND: We compared the port access mitral valve surgery with the conventional procedure through median sternotomy in a prospective randomized study. METHODS: Forty elective patients with mitral valve disease were prospectively randomized to undergo minimally invasive (group I) or conventional (group II) mitral valve operation. The patients of group I had limited access through right small anterior thoracotomy and a femorofemoral cardiopulmonary bypass system using the endoclamp technique. To assess the efficiency and safety of the procedure, intraoperative and postoperative clinical data and markers of myocardial, cerebral, and lower limb ischemia were collected. Pulmonary function tests were performed to compare the preservation of pulmonary function. Neuropsychological tests were conducted for quantification of neurological and cognitive disorders. RESULTS: Mitral valve reconstructions were performed in 28 patients (70%) in both groups. Intraoperative procedure-associated problems were experienced in 9 patients (45%) in group I, and 6 of them (30%) had to be converted to direct transthoracic aortic clamping. Markers of myocardial and cerebral damage as well as pulmonary and neuropsychological tests did not show statistically significant difference between groups. CONCLUSIONS: The minimally invasive port access technique for mitral valve surgery can be done with similar clinical safety as procedures through median sternotomy. The problems with endoclamping have forced us to change our practice to the more simple and economic transthoracic aortic clamping technique.

Cardiopulmonary Bypass↗

PubMed2005

Initial experience with a minimized extracorporeal bypass system: is there a clinical benefit?

BACKGROUND: Drawbacks of conventional cardiopulmonary bypass (CPB) are increased inflammatory response, deteriorated coagulation and systemic organ dysfunction. A closed extracorporeal circuit (CorX) features reduced foreign surface area and priming volume. Potential benefits were studied in comparing the CorX system with conventional CPB in arrested heart coronary artery bypass grafting (CABG). METHODS: Two hundred and four patients were randomly assigned either to CorX system (n = 101, group A) or a standard CPB with cardiotomy reservoir (n = 103, group B). Besides evaluation of perioperative data and routine blood samples, we focused on lung function and perioperative bleeding. Polymorphonuclear elastase (PMNE) and terminal complement complex (TCC) served to assess inflammatory response. RESULTS: Patient demographics and operative data did not differ between groups. Postoperative lung function was not significantly impaired comparing groups A and B. Intraoperative blood loss was significantly higher in group A compared with group B (1245 +/- 947 mL vs 313 +/- 282 mL, p < 0.0001) as well as the need of fresh frozen plasma. Postoperative chest drainage did not differ significantly between groups. Two patients in each group required re-exploration due to bleeding. One hour after CPB, PMNE as well as TCC were significantly lower in group A compared with group B (PMNE: 76 +/- 44 ng/mL vs 438 +/- 230 ng/mL, p < 0.0001; TCC: 16 +/- 8 IU/mL vs 29 +/- 19 IU/mL, p < 0.0001). CONCLUSIONS: The CorX system is safe and feasible in patients undergoing CABG. Despite of markedly reduced inflammatory reaction, no clinical benefit was observed.

Aged↗

PubMed2005

Do pulmonary autografts provide better outcomes than mechanical valves? A prospective randomized trial.

BACKGROUND: The objective of this study was to compare the performance of pulmonary autografts with mechanical aortic valves, in the treatment of aortic valve stenosis. METHODS: Forty patients with aortic valve stenoses, and below the age of 55 years, were randomly assigned to receive either pulmonary autografts (n = 20) or mechanical valve (Edwards MIRA; Edwards Lifesciences, Irvine, CA) prostheses (n = 20). Clinical outcomes, left ventricular mass regression, effective orifice area, ejection fraction, and mean gradients were evaluated at discharge, 6 months, and one year after surgery. Follow-up was complete for all patients. RESULTS: Hemodynamic performance was significantly better in the Ross group (mean gradient 2.6 mm Hg vs 10.9 mm Hg, p = 0.0005). Overall, a significant decrease in left ventricular mass was found one year postoperatively. However, there was no significant difference in the rate and extent of regression between the groups. There was one stroke in the Ross group and one major bleeding complication in the mechanical valve group. Both patients recovered fully. CONCLUSIONS: In our randomized cohort of young patients with aortic valve stenoses, the Ross procedure was superior to the mechanical prostheses with regard to hemodynamic performance. However, this did not result in an accelerated left ventricular mass regression. Clinical advantages like reduced valve-related complications and lesser myocardial strain will have to be proven in the long term.

Aortic Valve Stenosis↗

PubMed2005

Decreased intermediate term patency of automated proximal anastomoses evaluated by sequential ultrafast CT.

OBJECTIVE: The Symmetrytrade mark aortic connector creates proximal anastomoses of saphenous vein grafts using a nitinol implant. The device avoids partial clamping and thus possibly reduces neurologic complications. To evaluate graft patency, a single surgeon randomised study was performed in our institution. METHODS: Seventy-seven patients were randomised either to automated proximal anastomoses (group I, n=39, 61 vein grafts connected using the aortic connector, 47 as single, 15 as sequential bypasses) or controls (group II, n=38, 62 proximal anastomoses handsewn, 46 as single, 16 as sequential bypasses). Ultrafast CT-scans were performed on postoperative day 5 in 34 patients of group I and 16 patients of group II to evaluate early graft patency. Intermediate term patency was evaluated with ultrafast CT-scan in 30 patients of group I (46 grafts) and 25 patients of group II (39 grafts) 1 year after the operation. RESULTS: Two early graft occlusions were detected in group I (3.8%). In group II all evaluated grafts were patent 5 days after surgery. 11.4 months after surgery, seven out of 46 grafts were found occluded (15.2%) in group I. In the control group, only one occlusion was detected (2.6%). CONCLUSIONS: We observed a trend towards an increased occlusion rate 1 year after surgery with automated connector devices. For evaluation of long-term patency larger patient groups have to be evaluated. Other benefits of these devices have to be proven to promote their clinical application.

Adult↗

PubMed2005

Emergency endovascular interventions for acute thoracic aortic rupture: four-year follow-up.

OBJECTIVE: High mortality and paraplegia rates associated with the surgical management of acute thoracic aortic ruptures limit its success. It was our objective to evaluate whether emergency endovascular interventions would improve the outcomes of these patients. METHODS: Sixty patients aged 28 to 83 years were admitted to our institution with an acute rupture of the thoracic aorta (27 ruptured aneurysms, 15 perforated type B dissections, 18 traumatic ruptures). Twenty-eight patients were treated surgically with cardiopulmonary bypass, and 32 patients were acutely treated with an endovascular stent graft. Medical records were reviewed for prehospital and emergency department data, operative findings, and outcomes. Patients were followed up at yearly intervals with high-resolution multidetector computed tomographic angiography. RESULTS: Perioperatively, there were 1 death (3.1%) among the 32 patients in the endovascular group and 5 deaths (17.8%) among the 28 patients in the surgical group. There were 4 late deaths in the endovascular group and 1 in the surgical group. There were 2 access failures in the endovascular group. There were 1 stroke in the endovascular group and 1 case of paraplegia in the surgical group. Three patients in the endovascular group had endovascular leaks develop that required reintervention. Two patients in the endovascular group had late thrombosis of the left subclavian artery. CONCLUSION: Despite encouraging early outcomes, midterm results suggest a trend toward increased reintervention and late complication rates in the endovascular group. Therefore continued surveillance of patients treated with stent grafts is necessary.

Aged↗

PubMed2005

Closure of atrial and ventricular septal defects should be performed by the surgeon.

Surgeons look back on 57 years of experience in the closure of atrial septal defects (ASDs) and 46 years in the closure of ventricular septal defects (VSDs). The transcatheter approaches to repair ASDs started first in the 1980s and for VSDs 8 years later. This study sought to reveal the surgical features only given by the surgical therapy and the limitation of interventional ASD and VSD closure. A variety of surgical techniques including the minimal invasive techniques for ASD or VSD closure are well described in recent publication with good results. The surgical trend is to improve the cosmetic outcome by minimizing the size of skin incision. The latest robotically assisted technique requires only four stab wound incisions. New techniques and devices have revolutionized the transcatheter technique but could not achieve the surgical ability to close all types of ASD or VSD, control arrhythmias, and correct additional valve disease or malformation. The mortality for interventional and surgical procedures approaches zero in recent publication. The residual shunting after surgical closure of ASD varies from 2% to 7.8% versus 5% to 33% after interventional closure. General complications caused by the surgical procedure are negligible; however, the shortness of hospital stay and the cosmetic appeal is an advantage of interventional ASD closure. There is no scientific comparison of surgical vs. interventional VSD closure yet.

Cardiac Catheterization↗