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PubMed1995

Comparison of porcine biological valves with pericardial valves--a 12-year clinical experience with 1123 bio-prostheses.

In order to evaluate selective differences of biological porcine valves versus pericardial valves and to analyze various valve models, 8 different bioprostheses (4 porcine valves, 4 pericardial valves) were studied in a 12-year follow-up. From 1978 to 1990, 476 porcine bioprostheses (Carpentier-Edwards: n = 104, Carpentier Edwards Supraanular: n = 59, Hancock I: n = 41, Hancock II: n = 272) and 647 pericardial valves (Hancock-Extracorporeal: n = 479, Ionescu-Shiley: n = 76, Carpentier-Edwards: n = 57, Mitroflow: n = 35) were implanted. At time of implantation, the patient age ranged from 21-85 years, mean 57.1 +/- 12.4 years. 831 patients were analyzed in the long-term follow-up (62.3 +/- 18.6 months, cumulative follow-up of 6632 patient-years). The incidences of thromboembolic complications (TE), endocarditis (E), primary tissue failure (PTF), rate of reoperation (ReOp), and late mortality due to prosthesis dysfunction were analyzed, calculated, and compared within the different valve models (actuarial data, chi 2 test, log rank analysis). The incidences of TE and E were lower for pericardial valves when compared with porcine bioprostheses (TE: 0.88 vs. 1.8%/patient year; E: 0.24 vs. 0.5%/patient year); within the 2 groups, the different valve models did not show any major differences. However, the incidence of PTF was significantly higher in the pericardial valve group, being 36 +/- 6.5%, 68 +/- 10% and 86 +/- 19.5% after 6, 8, and 10 years; the respective figures for the porcine valves were 6 +/- 3.5%, 18 +/- 7.1%, and 60 +/- 13.1% (p < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

Complications associated with penile implants used to treat impotence.

The complications associated with a variety of penile prostheses used in the treatment of 302 men with erectile dysfunction are described. Infection of the prostheses resulted in their removal from 11 patients (3.6%), antibiotic therapy and replacement in five men. Mechanical failures required reoperation in 43 men (14.2%); however, recent advances in prosthesis design have reduced this type of malfunction. Adverse psychological reactions prompted removal of the prostheses from two men. Despite these complications, this surgery is remarkably effective.

Adolescent↗
PubMed1995

Cylindrical cemented ankle arthroplasty: a prospective series with long-term follow-up.

From 1981 to 1985 28 ankle arthroplasties were performed using a congruent and cylindrical ankle design. The talus component was an anatomically shaped cap to cover the talus dome and the facets. The tibial component was congruent toward the talus and had two parallel bars on the back for fixation into the distal tibia. The diagnosis was osteoarthritis in 15 cases and rheumatoid arthritis in 11 cases (two bilateral cases). There were seven failures, giving a cumulative estimated survival rate of 70% for the prosthesis at 12 years.

Adult↗
PubMed2001

Recurring synovitis as a possible reason for aseptic loosening of knee endoprostheses in patients with rheumatoid arthritis.

We evaluated histologically samples of synovial tissue from the knees of 50 patients with rheumatoid arthritis (RA). The samples were taken during revision for aseptic loosening. The findings were compared with those in 64 knees with osteoarthritis (OA) and aseptic loosening and in 18 knees with RA without loosening. The last group had been revised because of failure of the inlay or the coupling system of a constrained prosthesis. All the patients had had a total ventral synovectomy before implantation of the primary prosthesis. In all three groups a foreign-body reaction and lymphocellular infiltration were seen in more than 80% of the tissue samples. Deposits of fibrin were observed in about one-third to one-half of the knees in all groups. Typical signs of the reactivation of RA such as rheumatoid necrosis and/or proliferation of synovial stromal cells were found in 26% of knees with RA and loosening, but not in those with OA and loosening and in those with RA without loosening. Our findings show that reactivation of rheumatoid synovitis occurs after total knee replacement and may be a cofactor in aseptic loosening in patients with RA.

Aged↗
PubMed2000

[Specific features of performing anesthesia and artificial circulation in cardiosurgical interventions during pregnancy].

The authors summed up the main principles of performing anesthesia and artificial blood circulation in cardiosurgical interventions in 5 women with 20-27 week pregnancy. In pregnant women with progressing cardiac failure due to a heart disease, thrombosis of the cardiac valve prosthesis, acute infectious endocarditis with the altered valve, large size tumor of the heart with disturbed valve function an emergency operation must be performed under conditions of artificial circulation. Operative treatment is the only effective method for saving life of the mother and fetus. The proposed complex preoperative preparation, intra- and postoperative management of the patients are thought to be an effective method of supporting operations on the heart under conditions of artificial blood circulation in pregnant women. In order to prevent possible complications antioxidants should be included in the complex of anesthesiologic means. During operations with artificial circulation in pregnant women it is necessary to strive for performing normothermal perfusions with high volume velocities.

Acute Disease↗
PubMed2006

The implications of 18F-FDG PET for the diagnosis of endoprosthetic loosening and infection in hip and knee arthroplasty: results from a prospective, blinded study.

BACKGROUND: The most frequent complications of joint arthroplasty are septic or aseptic loosening of endoprostheses. Preoperative differentiation is essential, since very different treatment methods result from the diagnoses. The aim of the current study was to evaluate the clinical value of 18F-Fluoro-deoxyglucose positron emission tomography (18F-FDG PET) as a diagnostic modality for inflammation and loosening in hip and knee joint prostheses. METHODS: 18F-FDG-PET examinations and multiphase bone scan were performed on hip and knee endoprostheses in 27 patients prior to revision surgical procedures planned for prosthetic loosening. Intact prostheses were found at the opposite site in some patients so that additional 9 joints could be examined with the field of view of 18F-FDG PET. Verification and valuation of the PET and scintigraphic image findings were conducted by comparing them with information combined from intraoperative findings, histopathology, and microbiological investigations. RESULTS: Evidence of loosening was correctly determined in 76.4% of cases using 18F-FDG-PET, and in 75% of cases using bone scan. The detection of periprosthetic inflammation using 18F-FDG-PET had a sensitivity of 100% for septic cases and of 45.5% in cases of increased abrasion and aseptic foreign-body reactions. However, reliable differentiation between abrasion-induced and bacterial-caused inflammation was not possible using 18F-FDG-PET. CONCLUSION: 18F-Fluoro-deoxyglucose positron emission tomography (18F-FDG-PET) allows reliable prediction of peri-prosthetic septical inflammatory tissue reactions. Because of the high sensitivity of this method, a negative PET result in the setting of a diagnostically unclear situation eliminates the need for revision surgery. In contrast, a positive PET result gives no clear differentiation regarding the cause of inflammation.

Aged↗
PubMed1993

[Sutureless aortic valve replacement for peri-annular pseudoaneurysm and perivalvular leakage due to prosthetic valve endocarditis].

A 49-year-old man who had undergone AVR entered our hospital with congestive heart failure and continuing slight fever. By cardiac imaging, he was diagnosed prosthetic valve endocarditis with periannular pseudoaneurysm and perivalvular leakage. He underwent a new translocation method using a composite valve (a prosthetic valve directly sutured a ring prosthesis, which was separated from an intraluminal ringed graft). Post operative course was uneventful. He recovered well after the operation.

Aneurysm, False↗
PubMed2001

Early failures in total knee arthroplasty.

Total knee arthroplasty is a predictable operation. Unfortunately, there is a subset of patients who do not do well and require revision surgery within the first 5 years. The purpose of the current study was to analyze the mechanisms of failure in patients who had revision surgery within 5 years of their index arthroplasty. Between 1986 and 1999, 440 patients with total knee arthroplasties were referred for revision surgery. An analysis of patients in whom the arthroplasties failed within 5 years of the index arthroplasty and the reasons for early failure were documented. Of the 440 patients who had revision surgery, 279 (63%) had revision surgery within 5 years of their index arthroplasty: 105 of the 279 patients with early failures (38%) had revision surgery because of infection; 74 (27%) had revision surgery because of instability; 37 (13%) had revision surgery because of failure of ingrowth of a porous-coated implant; 22 (8%) had revision surgery because of patellofemoral problems; and 21 (7%) had revision surgery because of wear or osteolysis. Only eight of the 279 patients with early failures (3%) had revision surgery because of aseptic loosening of a cemented implant. The remaining 12 patients had revision surgery because of miscellaneous problems. Host factors may prevent infection from ever being eradicated totally. The two other major patterns of failure in this series were failure of cementless fixation and instability. If all of the arthroplasties in the patients in this early failure group would have been cemented routinely and balanced carefully, the total number of early revisions would have decreased by approximately 40%, and the overall failures would have been reduced by 25%.

Arthroplasty, Replacement, Knee↗
PubMed2006

The effect of bacterial contamination on neointimal hyperplasia in vascular grafts.

Neointimal hyperplasia (NH) is the most significant contributing factor to long-term vascular graft failure. Inflammation is known to be important in its development; however, the role of bacterial infection is unclear. We examined the effect of contamination with common organisms on the development of NH in expanded polytetrafluoroethylene grafts. Thirty adult pigs were randomized into one of four groups: no infection, contamination with Staphylococcus aureus, mucin-producing Staphylococcus epidermidis, or Pseudomonas aeruginosa. An expanded polytetrafluoroethylene graft (6 mm x 3 cm) was placed as a common iliac artery interposition graft and was inoculated with 1-2 x 10(8) of the selected organism before closure. Grafts were explanted 6 weeks postoperatively. Microbiologic, histological, and morphometric evaluations were performed. All grafts were patent at the time of euthanasia. The mean areas of NH were 5.45 mm(2) in sterile grafts, 8.36 mm(2) in S. aureus, 7.63 mm(2) in S. epidermidis, and 11.52 mm(2) in P. aeruginosa grafts. Comparison of means via analysis of variance showed that P. aeruginosa grafts had significantly higher formation of NH than sterile grafts (P = 0.025). NH production in infected grafts appears to be organism specific and is significantly higher with P. aeruginosa than common Gram-positive organisms. Increased NH from subclinical infection may be a significant factor contributing to late graft failures.

Anastomosis, Surgical↗
PubMed2005

[What effect does of obesity have on the outcome of total hip and knee arthroplasty. Review of the literature].

As the prevalence of obesity worldwide continues to rise, defining the relationship between obesity and arthroplasty outcomes becomes increasingly important. The effect of obesity on the outcome of total hip or knee arthroplasty has been reported to be variable. Some authors believe that a high body weight will lead to less than optimal arthroplasty outcomes, because increased body weight leads to increased stress across the components and an increased load on the surrounding bone. Although this should, in turn, lead to a higher incidence of aseptic loosening or prosthetic failure in obese patients, studies have suggested that the effect of increased body weight and arthroplasty outcome are not so straightforward. The lower activity level typically observed in obese patients may partially counter the negative effects of increased weight on the bone-prosthesis interface. Although results do not show significant differences in all studies, it appears that obesity has negative impact on the results of total hip and knee arthroplasty. Therefore, long-term studies using large sample sizes should be conducted. If significant differences are demonstrated, an altered course of treatment, such as having a patient lose weight before considering a total hip or knee arthroplasty, might be advocated.

Arthroplasty, Replacement, Hip↗
PubMed2002

Haemophilus parainfluenzae complicating total hip arthroplasty: a rapid failure.

We present a case of rapid failure of a total hip arthroplasty caused by infection with Haemophilus parainfluenzae. The septic loosening occurred over a period of 3 months and followed a dental extraction that had not been covered by prophylactic antibiotics. This failure occurred in a previously well-functioning and asymptomatic prosthetic joint.

Aged↗
PubMed1993

Total hip arthroplasty in sickle cell hemoglobinopathy.

Twenty-two arthroplasties were performed in 14 patients with sickle cell hemoglobinopathy (SCH). There were 15 primary and seven revision procedures; none were lost to follow-up evaluation. In the primary arthroplasty group, there were two deaths in patients whose implants were functioning well. The remaining 13 hips had a mean follow-up period of 4.8 years. Failure occurred in five of these 13 hips (38%), four due to aseptic acetabular loosening and one due to sepsis. In the revision arthroplasty group, at a mean follow-up period of 5.3 years, failure occurred in three hips (43%), one due to acetabular loosening, one due to femoral loosening, and one due to sepsis. Perioperative complication rates were high in both groups. Femoral intramedullary sclerosis and bone altered by marrow hyperplasia were associated with intraoperative technical difficulties as well as problems with achieving long-term component fixation. Though total hip arthroplasty provides the most reliable measure of effective treatment in SCH, it carries a high risk of complications and failure.

Adolescent↗
PubMed2006

Successful percutaneous closure of paraprosthetic aorto-right ventricular leak using the Amplatzer duct occluder.

A 55-year-old male with persisting aorto-right ventricular paraprosthetic leak after mitroaortic valve replacement was hospitalized for recurrent heart failure. Depressed left ventricular ejection fraction and severe pulmonary hypertension with increased right and left ventricular filling pressures were associated with significant left to right shunting through the leak. Elective closure of the leak was obtained with a 6-4 mm Amplatzer duct occluder. No complications were observed, and the patient experienced complete resolution of heart failure symptoms, with NYHA class I heart failure 12 months after discharge.

Aortic Valve↗
PubMed2004

Migration of polyethylene particles around nonloosened cemented femoral components from a total hip arthroplasty-an autopsy study.

Three cemented femoral components from total hip arthroplasties retrieved at autopsy were examined in regard to the migration of birefringent polyethylene particles across the fixation interfaces. They were obtained from two patients who died from unrelated causes. They had been in place, respectively, for 8 and 9 years (first patient) and for 9 years (second patient). Osteolysis was present in the acetabular side only. The femoral components were not loosened. Histologic sections were performed at four levels of the femoral components, and polyethylene particles were counted with the use of a semiautomatic image analyzer. Sections below the tip of the stem were treated by deorganification and the lysate was centrifuged in the attempt to isolate wear debris. Particles were found at both interfaces (bone-cement and metal-cement) and in the cancellous bone between the trabeculae. They were also present in the Haversian canals of the cortical bone. Particles of various sizes were found in the medullary canal beneath the tip of the stem. In scanning electron microscopy, they appeared to have irregular shapes. Wear debris can migrate across the cement-bone interface of nonloosened implants. They appear to progress through the porosity of the cancellous bone.

Aged↗
PubMed2005

Fatigue sensitivity of Y-TZP to microscale sharp-contact flaws.

The strength degrading effects of sharp-contact damage are examined for Y-TZP ceramic plates bonded to a plastic substrate. Contacts are made with Vickers and Berkovich diamond indenters at low loads (0.1 N to 100 N) in the ceramic lower surfaces prior to bonding to the substrates. The indentations remain in the subthreshold region, that is, without visible corner radial cracks, over the lower region (< 10 N) of the load range. A concentrated load is then applied sinusoidally to the ceramic upper surface, with the loading axis centered on the subsurface indentation flaw, thereby subjecting the flaw to cyclic tension. Relative to polished surfaces, the indentations diminish the single-cycle strength by an amount that increases with increasing indentation load. The critical number of cycles required to cause failure from the indentation flaws is then measured at specified maximum lower surface tensile stresses. At each indentation load, the strength of the ceramic plates diminishes with increased cycling. The scale of degradation is compared with that from previous studies on Y-TZP surfaces containing larger-scale surface damage: sandblast damage, as used in dental crown preparation; and blunt-contact trauma from a spherical indenter at 3000 N. These other damage modes are shown to be equivalent in their strength-degrading capacity to diamond pyramid indentations in the microscale load range 0.1 N to 1 N, attesting to the highly deleterious nature of sharp particulate contacts. The mechanism of fatigue is considered in terms of microcrack evolution within the indentation damage zone.

Equipment Failure Analysis↗
PubMed1994

The risks of reoperation for prosthetic valve dysfunction.

A retrospective study was conducted on 124 patients who underwent re-replacement of previously implanted prosthetic heart valves for structural valve failure, prosthetic valve endocarditis, periprosthetic leak, a thrombosed valve, hemolysis, or prophylactic removal. In total, 85% of the explanted valves were bioprostheses, and 70% of the newly implanted valves were mechanical valves. The overall operative mortality rate was 8.1%, being 3.2% of 95 single valve recipients and 25.0% of 28 double valve recipients (P < 0.001). The overall mortality rate dropped from 13.6% of 66 patients before 1988, to 1.7% of 58 patients encountered in the last 3 years (P < 0.02). Since 1988, a third of the patients have undergone reoperation without homologous blood transfusion. A univariate analysis revealed eight operative risk factors, namely: higher values of preoperative blood urea nitrogen or total bilirubin, double valve replacement at the redo operation, NYHA class IV, urgency of reoperation, a duration of implantation of less than 3 months, reoperation in the earlier period of this study, and reexploration for bleeding or cardiac tamponade after re-replacement surgery. A multivariate statistical analysis demonstrated that preoperative blood urea nitrogen, urgency of reoperation, double valve replacement, and the duration of implantation were independent risk factors. Thus, we recommend that surgery be performed early, before the occurrence of other organ failure induced by congestive heart failure due to any form of valve dysfunction.

Adolescent↗
PubMed2006

Obstruction of the left ventricular outflow tract due to pannus formation after the implantation of a carbomedics aortic valve.

Excessive pannus formation after implantation of a prosthetic valve is an infrequent but serious complication. A 69-year-old woman who had received a 19-mm CarboMedics aortic valve 11 years ago was readmitted to our hospital with dyspnea and chest oppression. Cineradiography did not show the restriction of valve movement. The aortic peak pressure gradient was calculated by Doppler echocardiography to be 104 mmHg. Based on the diagnosis of stenosis of the left ventricular outflow tract, the patient underwent reoperation. At reoperation, the pannus had formed circumferentially without disturbing the movement of the leaflet. A 19-mm St. Jude Medical Regent valve was implanted after enlargement of the aortic annulus. The patient's postoperative course was uneventful. We report this characteristic finding of pannus formation after the implantation of a CarboMedics valve in the aortic position.

Aged↗