Standardization of aortic valve repair techniques with use of a calibrated annuloplasty have led to improved long-term outcomes in dystrophic aortic insufficiency. It can also improve dissemination of techniques and rates of aortic valve repair. Dystrophic aortic insufficiency can be found in three aortic phenotypes: dilated aortic root, dilated ascending aorta and isolated aortic insufficiency. The aortic annulus is invariably dilated above 25 mm in the vast majority of cases of aortic insufficiency, regardless of whether the aorta is dilated or not. A dilated annulus is a risk factor for late failure of aortic valve repair if not addressed at the time of surgery. We perform a calibrated annuloplasty at both sub- and supra-valvular levels in order to restore the ratio of sinotubular junction and annulus. Current evidence shows aortic valve repair reduces valve-related mortality compared to prosthetic valve replacement, with an improved quality of life.
- MeSH
- anuloplastika srdeční chlopně * škodlivé účinky přístrojové vybavení mortalita MeSH
- aortální aneurysma diagnostické zobrazování mortalita patofyziologie chirurgie MeSH
- aortální chlopeň diagnostické zobrazování patofyziologie chirurgie MeSH
- aortální insuficience diagnostické zobrazování mortalita patofyziologie chirurgie MeSH
- chirurgická náhrada chlopně * škodlivé účinky přístrojové vybavení mortalita MeSH
- hemodynamika MeSH
- kvalita života MeSH
- lidé MeSH
- obnova funkce MeSH
- rizikové faktory MeSH
- srdeční chlopně umělé MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
BACKGROUND: Accumulated endovascular aneurysm repair (EVAR) procedures will increase number of patients requiring conversion to open repair of abdominal aortic aneurysms (AAA). In most cases, patients undergo late open surgical conversion (LOSC), many months, or years, after initial EVAR. The aim of this study is to analyze results of LOSC after EVAR in elective and urgent setting, including presenting features, surgical techniques, as well as to review the clinical outcomes and their predictors. METHODS: Retrospective review of all consecutive patients undergoing LOSC after EVAR was performed at three distinct, high volume, vascular centers. Patients that required primary conversion within 30 days after EVAR have not been included in this study. Between January 1st 2010 and January 1st 2017 total of 31 consecutive patients were treated. LOSC were performed either in elective or in urgent setting, thus dividing patients in two groups. Primary outcome was 30-day mortality and secondary postoperative complications. RESULTS: LOSC rate after EVAR was 4.51%. Most common indication for LOSC was type I endoleak (N.=20, 64.51%). All patients that presented with ruptured AAA had some form of endoleak (type I endoleak was present in five from six cases). Most common site for aortic cross-clamping was infrarenal (51.61%). Stent-graft was removed completely in 18 patients (58.06%) and partially in 13 (41.93%). 30-day mortality rate was 16.12% (5 patients) and most common cause of death was myocardial infarction (60%). Following univariate factors were isolated as predictors for 30-day mortality: preoperative coronary artery disease, chronic obstructive pulmonary disease, urgent LOSC, prolonged time until LOSC, ruptured AAA, supraceliac clamp, higher number of red blood cell transfusion, postoperative myocardial infarction, and prolonged intubation (more than 48 hours). CONCLUSIONS: LOSC seems to be safe and effective procedure when preformed in elective manner. On the other side, urgent LOSC after EVAR is associated with very high postoperative mortality and morbidity. Endoleak remains the main indication for open conversion. Further studies are necessary to standardize timing and treatment options for failing EVAR.
- MeSH
- aneurysma břišní aorty diagnostické zobrazování mortalita chirurgie MeSH
- časové faktory MeSH
- cévy - implantace protéz škodlivé účinky metody MeSH
- databáze faktografické MeSH
- endoleak chirurgie MeSH
- endovaskulární výkony škodlivé účinky metody MeSH
- konverze na otevřenou operaci metody mortalita MeSH
- lidé středního věku MeSH
- lidé MeSH
- míra přežití MeSH
- mortalita v nemocnicích MeSH
- multivariační analýza MeSH
- prediktivní hodnota testů MeSH
- příčina smrti * MeSH
- prognóza MeSH
- reoperace metody MeSH
- retrospektivní studie MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- specializovaná centra se zvyšujícím se počtem výkonů a tím zvyšující se kvalitou léčby MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
AIM: We sought to compare clinical outcomes, in-hospital mortality and 1-year survival of two different treatment modalities of deep sternal wound infection, topical negative pressure and the closed irrigation therapy. METHODS: Retrospective analysis of 66 consecutive patients treated for deep sternal infection at our institution. A total of 28 patients (February 2002 through September 2004) underwent primarily closed irrigation therapy, and 34 patients (November 2004 through December 2007) had the application of topical negative pressure. Four patients (July 2004 through December 2004) who underwent a combination of both strategies were excluded from the study. Clinical and wound care outcomes were compared, focusing on therapeutic failure rate, in-hospital stay and the 1-year mortality of both treatment strategies. RESULTS: Topical negative pressure was associated with a significantly lower failure rate of the primary therapy (P<0.05), shortening of the intensive care unit stay (P<0.001), a particular decrease in the in-hospital stay (P<0.05) and the 1-year mortality (P<0.05) in comparison with closed irrigation therapy. Comparable overall length of the therapy, in-hospital stay and the risk of wire-related fistulas after chest reconstruction were found. CONCLUSION: Topical negative pressure is a superior method of treatment for deep sternal wound infection, which is based on lower therapeutic failure rate, significant decrease in-hospital stay, and the decrease of the 1-year mortality rate, compared with primarily applied closed irrigation.
- MeSH
- časové faktory MeSH
- debridement metody MeSH
- délka pobytu trendy MeSH
- hojení ran MeSH
- infekce chirurgické rány terapie MeSH
- kardiochirurgické výkony škodlivé účinky metody MeSH
- léčebná irigace metody MeSH
- lidé MeSH
- mortalita v nemocnicích trendy MeSH
- následné studie MeSH
- retrospektivní studie MeSH
- rizikové faktory MeSH
- senioři MeSH
- sternotomie škodlivé účinky MeSH
- sternum MeSH
- terapie ran pomocí řízeného podtlaku metody MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- srovnávací studie MeSH
- Geografické názvy
- Švédsko MeSH
Extracorporeal membrane oxygenation (ECMO) is an established rescue treatment option for severe respiratory and cardiac failure in infants and neonates and has recently become widely utilised in adults. ECMO support can be initiated rapidly in an emergency setting both by percutanous implantation and surgically; it allows transportation of patients in cardio-pulmonary collapse and bridging of critically ill patients to be recovered, other support measures or transplantation. The aim of this study was to report authors' initial experience after starting an ECMO program in a university-based cardiac center. The institutionally approved ECMO team bears responsibility for adjudication regarding indication and implementation of ECMO in all patients. Since the establishment of the ECMO team in October 2007, one elective and nine urgent patients in deep cardiogenic and/or ventilatory collapse were treated by ECMO support up to December 2008. Three patients suffered severe acute right heart dysfunction, two patients suffered postcardiotomy refractory cardiogenic shock, two patients had a cardiogenic shock due to postinfarction interventricular septal rupture, two patients experienced severe respiratory failure and one had elective ECMO implantation as a back-up support during high-risk percutaneous coronary intervention. Veno-arterial ECMO was used in eight cases and veno-venous in two cases of isolated respiratory failure. In nine patients, ECMO circuit was instituted by peripheral cannulation, in eight out of nine cases by percutaneous puncture. On one occasion central surgical cannulation was used. In urgent patients, immediate hemodynamic and oxygenation improvement was observed. Average support duration was 6.8 days (range 1-16 days). Five (50 %) patients were successfully weaned from ECMO and survived to hospital discharge. The illness severity in urgent patients defined by SOFA score ranged from 10 to 17, patients dying while on ECMO had higher SOFA scores (14.8±1.6 vs. 10.8±1.5; P=0.0065). Complications included mainly bleeding. ECMO support allows treatment of severely ill patients in imminent cardiovascular and/or ventilatory collapse. Therefore, establishment of an ECMO program in university affiliated cardiac center is fully justified. A multidisciplinary approach is essential. Despite adequate training and education of ECMO team members, this highly invasive therapeutic modality bears an inherent risk of complications.
- MeSH
- časové faktory MeSH
- dospělí MeSH
- hodnocení programu MeSH
- kritický stav MeSH
- lidé středního věku MeSH
- lidé MeSH
- mimotělní membránová oxygenace škodlivé účinky mortalita MeSH
- mortalita v nemocnicích MeSH
- nemoci srdce etiologie mortalita patofyziologie terapie MeSH
- nemocnice fakultní MeSH
- respirační insuficience etiologie mortalita patofyziologie terapie MeSH
- senioři MeSH
- stupeň závažnosti nemoci MeSH
- týmová péče o pacienty MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Česká republika MeSH
IM: We sought to compare the impact of endoscopic and minimally invasive great saphenous vein harvesting on leg-related patient morbidity after coronary artery bypass grafting. METHODS: From February 2004 to July 2006, 120 patients underwent minimally invasive vein harvesting, and 180 patients underwent endoscopic vein harvesting for coronary artery bypass grafting. Patients were evaluated prospectively for wound-healing disturbances, residual leg edema, pain intensity and saphenous neuropathy at seven days, three months and one year after surgery. RESULTS: Both harvesting techniques were associated with a low incidence of wound-healing disturbances; nevertheless, endoscopic vein harvesting was associated with a significantly lower incidence of residual edema (12% vs 28%, P<0.05 seven days postoperative; 6% vs 19%, P<0.001 three months postoperative), pain (9% vs 20%, P<0.05; 6% vs 10%, P<0.05) and saphenous neuropathy (6% vs 23%, P<0.001; 3% vs 14%, P<0.05) during follow-ups. Endoscopic vein harvesting was also associated with a significantly lower incidence of neurological disturbances at one-year follow-up (2% vs 8%, P<0.05). Mean harvesting time (43.9+/-10.2 vs 40.6+/-15.5 min, P=0.09), conversion rate (2% vs 3%, P=0.71) and injury per conduit (0.3+/-0.1 vs 0.3+/-0.2, P=0.91) were comparable for both groups. CONCLUSION: EVH is superior to MIVH in terms of reduction in pain intensity, residual leg edema and saphenous neuropathy at seven days and again at three months postoperative. A significantly lower incidence of neurological disturbances is still presented one year after surgery.
- MeSH
- bérec krevní zásobení ultrasonografie MeSH
- endoskopie metody MeSH
- hojení ran fyziologie MeSH
- koronární bypass mortalita MeSH
- lidé MeSH
- miniinvazivní chirurgické výkony MeSH
- následné studie MeSH
- pooperační komplikace epidemiologie patofyziologie MeSH
- prospektivní studie MeSH
- rozdělení chí kvadrát MeSH
- senioři MeSH
- vény transplantace ultrasonografie MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- srovnávací studie MeSH
AIM: The aim of this retrospective study was to evaluate the effectiveness of Terlipressin in the treatment of severe hypotension in cardiosurgical patients and to assess the differences between the groups of survivors and nonsurvivors.
- MeSH
- analýza rozptylu MeSH
- hypotenze etiologie farmakoterapie MeSH
- intravenózní infuze MeSH
- kardiochirurgické výkony škodlivé účinky MeSH
- lidé MeSH
- lypresin analogy a deriváty aplikace a dávkování terapeutické užití MeSH
- neparametrická statistika MeSH
- přežívající MeSH
- retrospektivní studie MeSH
- rozdělení chí kvadrát MeSH
- senioři MeSH
- vazokonstriktory aplikace a dávkování terapeutické užití MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
IM: Patients with extensive aneurysm involving ascending aorta, aortic arch and descending aorta are usually treated by sequential operations. For these patients we can also use combined surgical and endovascular treatment. The experience with this procedure published in the literature is very limited. We report our experience in the ''elephant trunk'' technique followed by an endovascular stent-grafting of the descending thoracic aorta in a small group of three consecutive patients with extensive thoracic aortic aneurysm. METHODS: Three consecutive patients with extensive thoracic aortic aneurysm or chronic dissection underwent combined surgical and endovascular treatment between January and December 2004. The procedure was carried out as a two-stage procedure. During the first stage aortic arch was replaced using the elephant-trunk'' method and during the second stage the stentgrafting of the descending aorta was performed. RESULTS: All three patients were treated successfully. There was no death, no endoleak and no permanent neurological deficit. One patient had a transient paraparesis. In all patients the spiral CT demonstrated excellent technical result without endoleak and with thrombosis of the paraprosthetic space. CONCLUSIONS: We can conclude, that the combined surgical and endovascular treatment of extensive thoracic aortic aneurysm is a feasible method which could reduce mortality and morbidity. In our institution the elephant trunk technique followed by an endovascular stent-grafting of the descending aorta is the preferred method of treatment in patients with extensive thoracic aortic aneurysm involving ascending aorta, aortic arch and descending aorta.
- MeSH
- anastomóza chirurgická MeSH
- aneurysma hrudní aorty chirurgie radiografie MeSH
- angioplastika MeSH
- cévy - implantace protéz MeSH
- disekce aorty chirurgie radiografie MeSH
- dospělí MeSH
- financování organizované MeSH
- kombinovaná terapie MeSH
- lidé středního věku MeSH
- lidé MeSH
- polyethylentereftaláty MeSH
- senioři MeSH
- stenty MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- MeSH
- dysfunkce levé srdeční komory diagnóza komplikace MeSH
- finanční podpora výzkumu jako téma MeSH
- kardioplegické roztoky terapeutické užití MeSH
- kontrakce myokardu genetika MeSH
- koronární bypass metody MeSH
- lidé MeSH
- nemoci koronárních tepen chirurgie MeSH
- vyvolaná zástava srdce metody MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- srovnávací studie MeSH
