Texas Heart Institute journal
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In this study, we reviewed a 15-year experience with the treatment of a severe sequela of cardiac surgery: post-sternotomy mediastinitis. We compared the outcomes of conventional treatment with those of negative-pressure wound therapy, focusing on mortality rate, sternal reinfection, and length of hospital stay. We reviewed data on 157 consecutive patients who were treated at our institution from 1995 through 2010 for post-sternotomy mediastinitis after cardiac surgery. ⋯ Significantly shorter hospital stays were also observed with negative pressure in comparison with conventional treatment (mean durations, 27.3 ± 9 vs 30.5 ± 3 d; P = 0.02), consequent to the accelerated process of wound healing with negative-pressure therapy. Lower mortality and reinfection rates and shorter hospital stays can result from using negative pressure rather than conventional treatment. Therefore, negative-pressure wound therapy is advisable as first-choice therapy for deep sternal wound infection after cardiac surgery.
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Case Reports
Pulmonary valve leaflet extension with bovine pericardium: for treatment of pulmonary insufficiency.
Using a homograft in a pulmonic area is sometimes inadvisable due to the lack of optimal graft materials. We report a case of pulmonary valve insufficiency that we treated by leaflet extension using the commercially available E-Leafcon template and bovine pericardium. We suggest that this method can be an acceptable alternative for treating pulmonary valve insufficiency because the pulmonary valve area is similar to that of the aortic valve (for which application the template was designed). Further, the durability of bovine pericardium is comparable to that of a homograft or a xenograft.
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Heart-failure phenotypes include pulmonary and systemic venous congestion. Traditional heart-failure classification systems include the Forrester hemodynamic subsets, which use 2 indices: pulmonary capillary wedge pressure (PCWP) and cardiac index. We hypothesized that changes in PCWP and central venous pressure (CVP), and in the phenotypes of heart failure, might be better evaluated by cardiovascular modeling. ⋯ Herein, we propose a system for classifying heart-failure phenotypes on the basis of discordant or concordant heart failure. A surrogate marker, PCWP-CVP separation, in a simplified situation without complex valvular or pulmonary disease, shows that discordant left and right ventricular failures are characterized by differences of ≥ 4 and ≤ 0 mmHg, respectively. We validated the proposed model and classification system by using published data on patients with acute and chronic heart failure.
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Multiple lines of evidence establish a relationship between BAV and proximal aortic aneurysms. Emerging indications and techniques are leading to a more standardized surgical approach to these patients. In the individual patient, however, one must use judgment to determine the best approach on the basis of several factors, including age, comorbidities, extent of concomitant surgery, and the expected risk of subsequent complications.