The Thoracic and cardiovascular surgeon
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Thorac Cardiovasc Surg · Jun 2017
Comparative StudyTitanium Plate Fixation versus Conventional Closure for Sternal Dehiscence after Cardiac Surgery.
Background Postoperative sternal dehiscence with or without mediastinitis is a complication of cardiac surgery leading to considerable disability. Titanium plate fixation can provide sternal stability in patients with a dehiscent sternum. The aim of this study is to compare clinical outcomes of titanium plate fixation with conventional treatment methods such as steel wire cerclage and pectoralis muscle reconstruction. ⋯ Hospital stay was similar in both groups (10 [5-23] vs. 12 (5-21) days, p = 0.527). There was no inhospital mortality. Conclusion Titanium plate fixation is superior in stabilizing the sternal bone when compared with conventional refixation methods, especially in secondary closure after poststernotomy mediastinitis.
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Thorac Cardiovasc Surg · Jun 2017
Randomized Controlled Trial Comparative StudyDouble-Wire versus Single-Wire Sternal Closure in Obese Patients: a Randomized Prospective Study.
Background Sternal instability after coronary artery bypass grafting (CABG) is a serious complication. Obese patients are at high risk for sternal instability after CABG. This study was conducted to assess the positive impact of double-wire sternal closure on sternal instability. ⋯ Logistic regression analysis showed sternal closure via double wires as an independent protection factor (odds ratio [OR]: 0.276; p = 0.029). Smoking (OR: 5.5; p = 0.006) and postoperative delirium (OR: 3.5; p = 0.033) turned out to be independent risk factors for the development of sternal instability. Conclusion Double-wire sternal closure significantly reduces postoperative sternal instability in obese patients undergoing isolated CABG with LIMA graft.
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Thorac Cardiovasc Surg · Apr 2017
Hemodynamic Performance of Endovascular Valves as Valve-in-Valve in Small Stented Bioprosthesis.
Background Endovascular valve in stented biological valve implantation (valve-in-valve transcatheter aortic valve implantation [TAVI ViV]) is increasingly becoming a valid option for bioprosthesis degeneration. TAVI implantation in small stented biological valves below 23 mm is controversially discussed. Reduced opening area and high gradients are typical objections against this procedure in cases of small bioprosthesis. ⋯ Conclusion This in vitro study shows that hemodynamic performance of endovascular valves as ViV in small bioprosthesis does not differ significantly from the performance of the initial implanted prosthesis. Hemodynamic performance of porcine cusp valves could even be optimized. It can thus be speculated that TAVI ViV also offers a reasonable option for patients with typical stented bioprosthetic degeneration to substantially prolong adequate function with one initial surgical and one consecutive interventional procedure even in small valves.
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Thorac Cardiovasc Surg · Apr 2017
Comparative StudyConventional versus Transapical Aortic Valve Replacement: Is It Time for Shift in Indications?
Background The incidence of degenerative aortic valve diseases has increased along with the life expectancy of our population. Although conventional aortic valve replacement (AVR) is the gold standard for symptomatic aortic stenosis, transcatheter procedures have proven to be a valid therapeutic option in high-risk patients. The aim of this study was to compare these procedures in a high-risk cohort. ⋯ Patients in the TA-TAVI group had lower mean valvular gradients postoperatively compared with the AVR group (14.6 ± 6.6 vs. 10.2 ± 4.9 mm Hg, p < 0.001). Conclusion For high-risk patients, the TAVI procedure is comparable with conventional AVR, but is not advantageous. These results do not support the expansion of TAVI to low- or intermediate-risk patients.
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Thorac Cardiovasc Surg · Apr 2017
Modified Transsubxiphoid Thoracoscopic Extended Thymectomy in Patients with Myasthenia Gravis.
We developed a new minimally invasive thoracoscopic technique of extended thymectomy for myasthenia gravis by combining a subxiphoid incision with dual costal margin incisions. In our experience of 31 consecutive cases, this procedure provides a good operative view in the neck region and makes verification of the bilateral phrenic nerves easy. All the patients recovered smoothly with less trauma, less bleeding, less complication, and good cosmetic results. This modified transsubxiphoid approach is a satisfactory procedure for performing extended thymectomy in patients with myasthenia gravis.