Expert review of medical devices
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Expert Rev Med Devices · Oct 2017
ReviewRetrograde magnetic internal lengthening nail for acute femoral deformity correction and limb lengthening.
The Precice magnetic internal lengthening intramedullary nail is being used with great success in femur lengthening and deformity correction with a retrograde approach. Areas Covered: Our personal history of limb lengthening and the Precice nail will be reviewed. Several technical aspects are discussed including design updates, pre operative planning, selection of nail length, the use of blocking screws and intra operative temporary external fixation, osteotomy practice, post operative management, and cost analysis. ⋯ The few failures that have occurred appear to be attributable to excessive loading of the femur and implant during a vulnerable time of bone healing. Further studies with more uniform outcome criteria need to be conducted to better standardize user's experiences. The higher one time cost of the implant is offset by the reduced number of surgeries needed when compared with the gold standard of lengthening-over-nail-technique, and we suspect that patients return to work sooner due to the ability to wear normal clothing and the reduction in pain throughout the entire lengthening process.
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Expert Rev Med Devices · Oct 2017
ReviewUtilization of the Impella for hemodynamic support during percutaneous intervention and cardiogenic shock: an insight.
Impella is a catheter-based micro-axial flow pump placed across the aortic valve, and it is currently the only percutaneous left ventricular assist device approved for high-risk percutaneous coronary intervention and cardiogenic shock. Areas Covered: Even though several studies have repeatedly demonstrated the excellent hemodynamic profile of Impella in high-risk settings, it remains underutilized. ⋯ Expert Commentary: Percutaneous coronary interventions in high rsk settings have always been challenging for a physician. Impella 2.5 and CP, have been proven safe, cost effective and feasible in High Risk Percutaneous coronary Interventions with an excellent hemodynamic profile.
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Expert Rev Med Devices · Oct 2017
ReviewManagement of failing bioprosthesis in elderly patients who have undergone transcatheter aortic valve replacement.
Transcatheter aortic valve replacement (TAVR) has revolutionized the treatment of symptomatic aortic stenosis. The number of TAVR procedures is expected to increase exponentially in the next decade. Therefore, patients will inevitably present with signs and symptoms attributable to TAVR bioprosthesis failure many years after an acutely successful procedure. ⋯ Expert commentary: A key question for TAVR moving forward is its efficacy with regards to long-term durability. The 5-year durability of TAVR prosthesis is excellent but comprehensive longer-term follow-up is awaited. Other mechanisms of failure include: TAVR endocarditis, diagnosis can be challenging and it is essential to have high clinical suspicion; TAVR migration, a rare complication that can be treated with second TAVR prosthesis; TAVR thrombosis, either subclinical identified on computed tomography or obstructive symptomatic thrombosis identified on echocardiogram, both types are effectively treated by formal anticoagulation; TAVR compression, a phenomenon observed in post-mortem examination following cardiopulmonary resuscitation, treatment options include balloon post-dilatation and second TAVR prosthesis implantation.