Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Mar 2018
Surgical strategy for aortic arch reconstruction after the Norwood procedure based on numerical flow analysis.
Inefficient aortic flow after the Norwood procedure is known to lead to the deterioration of ventricular function due to an increased cardiac workload. To prevent the progression of aortic arch obstruction, arch reconstruction concomitant with second-stage surgery is recommended. The aim of this study was to determine the indications for reconstruction based on numerical simulation and to reveal the morphology that affects the haemodynamic parameters. ⋯ Determining the surgical strategy for arch reconstruction based on numerical flow analysis may effectively reduce the ventricular load even if no stenosis or pressure gradients are observed on catheter examination or echocardiography.
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Interact Cardiovasc Thorac Surg · Mar 2018
EuroSCORE II and the STS score are more accurate in transapical than in transfemoral transcatheter aortic valve implantation.
The European System for Cardiac Operative Risk Evaluation II (EuroSCORE II) and the Society of Thoracic Surgeons (STS) score are currently used to estimate periprocedural risk of death in patients undergoing transcatheter aortic valve implantation (TAVI). However, data regarding the predictive ability and usefulness of these scores for TAVI are controversial, especially for different access sites. ⋯ The EuroSCORE II and the STS score were independent predictors of 30-day and cumulative mortality rates in patients undergoing TAVI. The EuroSCORE II and the STS score were associated with 30-day mortality and mortality during follow-up period only in TA TAVI.
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Interact Cardiovasc Thorac Surg · Mar 2018
Novel arch fenestrated stent graft for acute Stanford Type A aortic dissection with open antegrade implantation.
The best surgical strategy for acute Stanford Type A aortic dissection (aTAAD) involving the arch remains controversial. Here, we report on the satisfactory results following aTAAD repair using a novel arch fenestrated stent graft. ⋯ In aTAAD patients, the use of the novel arch fenestrated stent graft achieved excellent aortic remodelling of the aortic arch and descending aorta without any increase in the morbidity and mortality.
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Interact Cardiovasc Thorac Surg · Feb 2018
Case ReportsThe Bridge Occlusion Balloon as a safety net in a high-risk transvenous lead extraction procedure.
Injuries to the superior vena cava (SVC) during transvenous lead extraction (TLE) procedures are a rare but life-threatening complication. The Bridge Occlusion Balloon (BOB) is specifically designed for temporary SVC occlusion in TLE procedures. We report the first case of a 27-year-old man using the BOB as a safety net in a high-risk TLE procedure. ⋯ Successful extraction of 2 dysfunctional leads, as well as venous recanalization, for the new right atrial and right ventricular lead implantation was achieved. We have shown the feasibility of using powered extraction sheaths with a deflated BOB in place. This allows for immediate balloon inflation, in case of an SVC perforation.
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Interact Cardiovasc Thorac Surg · Feb 2018
Impact of initial aortic diameter and false-lumen area ratio on Type B aortic dissection prognosis.
Medical treatment is the gold standard for uncomplicated acute Type B aortic dissection (ATBAD). Although endovascular treatment could become an alternative therapy, it is unclear which ATBAD patients should undergo endovascular intervention. We aimed to evaluate the outcomes of patients with uncomplicated ATBAD and identify the risk factors for major adverse events. ⋯ UMIN 000025388, https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000029229.