European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
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Eur J Cardiothorac Surg · Jun 2012
Aortic valve calcium scoring is a predictor of significant paravalvular aortic insufficiency in transapical-aortic valve implantation.
Transapical-aortic valve implantation (TA-AVI) has evolved as routine for selected high-risk patients. However, paravalvular leaks >1+ remain an unsolved issue using current generations of transcatheter valve devices. The purpose of this study was to investigate the impact of native aortic valve calcification on paravalvular leaks and outcomes using the Edwards SAPIEN™ prosthesis. ⋯ Severe native valve calcifications are predictive for postoperative relevant paravalvular leak. AVCS prior to TA-AVI might serve as an additional tool to reconsider the TAVI indication to reduce the risk of paravalvular leaks especially in so-called operable patients.
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Eur J Cardiothorac Surg · May 2012
Controlled Clinical TrialProspective trial evaluating sonography after thoracic surgery in postoperative care and decision making.
Following thoracic surgery, daily chest X-rays (CXRs) are performed to assess patient evolution and to make decisions regarding chest tube removal and patient discharge. Sonography after thoracic surgery (SATS) has the potential to be an effective, convenient, inexpensive and easy to learn tool in the post-operative management of thoracic surgery patients. We hypothesized that SATS could alleviate the need for repetitive CXRs, thus reducing the related risks, costs and inconvenience. ⋯ Post-operative ultrasound may alleviate the need to perform routine CXR in patients with a previously ruled out pneumothorax. SATS used selectively may be able to reduce the number of routine CXRs performed; however, it does not have high enough accuracy to replace CXRs.
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Eur J Cardiothorac Surg · May 2012
Management of anastomotic leakage-induced tracheobronchial fistula following oesophagectomy: the role of endoscopic stent insertion.
Tracheobronchial fistulas are rare but life-threatening complications after oesophagectomy. Leakage of the oesophagointestinal anastomosis with inflammatory involvement of the tracheobronchial tree is the predominant reason for postoperative fistulization between the airways and the oesophagus or the gastric tube. Successful management is challenging and still controversially discussed. After promising results in the treatment of intrathoracic anastomotic leaks, we adopted endoscopic stent implantation as the primary treatment option in patients with anastomotic leak-induced tracheobronchial fistula. The aim of this study was to investigate the feasibility, the limits and the results of this procedure. ⋯ Treatment of anastomotic leak-induced tracheobronchial fistulas by means of oesophageal and tracheal stent implantation is feasible. If stent insertion is limited by gastric tube necrosis or bronchial gangrene, the prognosis is likely to be fatal.
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Eur J Cardiothorac Surg · May 2012
Comparative StudyIn vitro comparison of three techniques for ventriculo-aortic junction annuloplasty.
In aortic valve repair, reduction and stabilization of the ventriculo-aortic junction (VAJ) is generally recommended. In this in vitro study, we compare three techniques of annuloplasty: the subcommissural annuloplasty (SCA), the internal ring (IR) and the external ring (ER) annuloplasty. ⋯ The three annuloplasty techniques examined demonstrated differential effects on aortic valve function and root morphology. The ER and IR have greater potential to reduce VAJ diameter in comparison to SCA. The IR induced a subvalvular remodelling of the VAJ, whereas the ER induced a paravalvular remodelling.