Less-invasive
Dotaz
Zobrazit nápovědu
BACKGROUND: The novel HeartMate 3 (Abbott, Chicago, IL, USA) left ventricular assist device (LVAD) was worldwide first implanted by Prof. Schmitto and his team in 2014 at the Hannover Medical School, Germany and received CE Mark approval in October, 2015 following completion of a clinical trial. METHODS: Although HeartMate 3 implantation in the clinical trial was restricted to conventional sternotomy, the small size of the pump allows for less-invasive implantation, generally associated with less trauma and reduced perioperative complication rates. Herein we describe our first experiences with a less-invasive implantation of the HeartMate 3 using an upper hemi-sternotomy combined with anterior lateral thoracotomy approach. RESULTS: Results demonstrate the feasibility of this novel, less invasive technique for HeartMate 3 LVAD implantation with diminished surgical trauma, less postoperative bleeding, maintenance of the chest stability, reduced need of blood product transfusion and earlier recovery. CONCLUSIONS: The results of our study indicate that less-invasive implantation of the HeartMate 3 is technically feasible and offers several benefits for surgical outcome and may become the standard of care for LVAD implantation techniques.
- Klíčová slova
- HeartMate 3, Less-invasive, implantation, left ventricular assist device (LVAD),
- Publikační typ
- časopisecké články MeSH
AIMS: Surgical ventricular reconstruction to remodel, reshape, and reduce ventricular volume is an effective therapy in selected patients with chronic heart failure (HF) of ischaemic aetiology. The BioVentrix Revivent TC System offers efficacy comparable to conventional surgical ventricular reconstruction and is less invasive utilizing micro-anchor pairs to exclude scarred myocardium on the beating heart. Here, we present 12-months follow-up data of an international multicenter study. METHODS AND RESULTS: Patients were considered eligible for the procedure when they presented with symptomatic HF [New York Heart Association (NYHA) class ≥II], left ventricular (LV) dilatation and dysfunction caused by myocardial infarction, and akinetic and/or dyskinetic transmural scarred myocardium located in the anteroseptal, anterolateral, and/or apical regions. A total of 89 patients were enrolled and 86 patients were successfully treated (97%). At 12 months, a significant improvement in LV ejection fraction (29 ± 8% vs. 34 ± 9%, P < 0.005) and a reduction of LV volumes was observed (LV end-systolic and end-diastolic volume index both decreased: 74 ± 28 mL/m2 vs. 54 ± 23 mL/m2 , P < 0.001; and 106 ± 33 mL/m2 vs. 80 ± 26 mL/m2 , respectively, P < 0.0001). Four patients (4.5%) died in hospital and survival at 12 months was 90.6%. At baseline, 59% of HF patients were in NYHA class III compared with 22% at 12-month follow-up. Improvements in quality of life measures (Minnesota Living with Heart Failure Questionnaire 39 vs. 26 points, P < 0.001) and 6-min walking test distance (363 m vs. 416 m, P = <0.001) were also significant. CONCLUSIONS: Treatment with the Revivent TC System in patients with symptomatic HF results in significant and sustained reduction of LV volumes and improvement of LV function, symptoms, and quality of life.
- Klíčová slova
- Device intervention, Heart failure, Myocardial infarction, Ventricular remodelling, Volume reduction,
- MeSH
- design vybavení MeSH
- funkce levé komory srdeční fyziologie MeSH
- ischemická choroba srdeční komplikace patofyziologie MeSH
- kardiochirurgické výkony přístrojové vybavení MeSH
- kvalita života MeSH
- lidé středního věku MeSH
- lidé MeSH
- následné studie MeSH
- prospektivní studie MeSH
- remodelace komor * MeSH
- srdeční komory diagnostické zobrazování patofyziologie chirurgie MeSH
- srdeční selhání etiologie patofyziologie chirurgie MeSH
- tepový objem fyziologie MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- práce podpořená grantem MeSH
- randomizované kontrolované studie MeSH
INTRODUCTION: In spite of the progress in diagnosis and therapeutic options, esophageal perforation resulting in mediastinitis is a very serious condition with a high morbidity. AIM: To evaluate the use of esophageal stents for the treatment of patients suffering from mediastinitis. MATERIAL AND METHODS: Retrospective (2008-2012) analysis of a group of patients requiring surgical treatment. The evaluation was focused on the cause of perforation, stent type and its parameters, the surgical method used, duration of stenting and total length of treatment. RESULTS: In total, 16 patients were treated by stenting. All patients were treated with the stent being placed across the defect in the esophagus. Mediastinitis was accessed and drained with the aid of a thoracotomy or thoracolaparotomy (8 cases), or using a combination of a laparotomy/laparostomy and pleural drainage (5 cases). The most basic interventions were either pleural or external cervical drainage (3 and 1 cases, respectively). One patient, in whom a stricture had developed at the healed perforation, was subjected to esophageal resection. Four patients died. The average period that the stent was left in situ was 53.7 days. The average period of hospitalization of those patients who survived was 53.4 days. CONCLUSIONS: Using stents in therapy neither increased survival (mortality of 25%), nor decreased the length of therapy of patients once mediastinitis had developed. The main advantage of stenting is the preservation of the native esophagus and the reduced extent of surgical mediastinal drainage.
- Klíčová slova
- esophageal perforation, esophageal stent, mediastinitis,
- Publikační typ
- časopisecké články MeSH
The treatment of distal femoral fractures has been associated with a high rate of complications for a long time. Although implants and surgical techniques have improved, plate osteosynthesis and intramedullary nailing have been accompanied by a high occurrence of infection, non-union and malalignment. The treatment of soft tissue envelopes using "biological" osteosynthesis and minimally invasive approaches has resulted in a decrease in complication rates and ultimately led to the concept of the less invasive stabilization system (LISS). This is an extramedullary-applied, internal fixator shaped according to the implantation site anatomy, with minimal invasiveness. The purpose of this study was to present this new surgical technique and draw attention to its advantages and importance. Although this is not a scientific paper, we hope to provide enough evidence of the LISS usefulness. The main LISS components include multiple-fixed angle screws and an insertion handle for submuscular sliding of a fixator and placement of percutaneous, self-drilling, unicortical screws for fixation of the diaphyseal fracture fragments. The LISS has been designed to preserve periosteal perfusion and to facilitate a minimally invasive application. Since the first implantation of the LISS, only a few studies have been published on its use in treatment of distal femoral fractures. The rate of infection has been low, ranging from 0 to 4%. The rate of delayed union has been between 2.4 and 6.1%, but delayed unions do not necessarily lead to secondary bone grafting or repeat osteosynthesis as the LISS has a high and lasting stability. When the LISS is used, bone grafting is rarely necessary (0 to 1.6% in primary and 0 to 5% in secondary grafting). Also implant failure differs from the failure of plate osteosynthesis because, with the use of LISS, no screw loosening or secondary malalignment occurs. Implant failures (up to 7.4%) were recorded particularly at the time of LISS introduction in surgical practice and were attributed to the technique of implantation rather than to the implant itself. Good treatment outcomes have been reported. The average knee flexion has been 103 degrees and 107 degrees. In 72.5% of the patients, flexion has been more than 90 degrees and an extension lag of > or = 10 degrees has been found in only 7.5% of all cases. The average Neer score has ranged from 73.9 to 77.2 points. In conclusion, the LISS is a useful implant for treatment of distal femoral fractures, especially when bone quality is poor. Infection, delayed union and non-union rates are low, as shown by yet unpublished data from our clinic. Primary bone grafting, which is rarely necessary with this system, is carried out only when there is a great bone loss. Implant failure, such as screw loosening or secondary malalignment, is not seen.
BACKGROUND AND OBJECTIVE: A new "less invasive" technique avoiding thoracic epidural analgesia has be en tested for suitability as a routine procedure for cardiac anesthesia. Early postoperative extubation is an important step in this fasttrack procedure. MATERIALS AND METHODS: Consecutive patients (n = 547; age, 35-82 years; mean age, 64 year s; male to female ratio, 3.5) underwent general anesthesia with ultra-short-acting opiates and then underwent coronary surgery (n = 465), valve surgery (n = 38), or combined and other procedures (n = 44) a r;. In 51.4% cases, coronary artery bypass grafting was performed off pump. The percentage of patients extubated within 10 minutes after skin closure was the primary end point. In addition, we attempted to identify the limiting factors of the procedure tested. RESULTS AND DISCUSSION: Of the 547 patients, 499 (91%) were extubated within 10 minutes after skin closure. Early extubation failed in 48 (9%) of the patients. The mortality rate was 1.5%. One (0.2%) of the patients needed early reintubation because of pneumothorax. Postoperative myocardial ischemia was recorded in 10 (1.8%) of the patients. Ninetysix (17.5%) of the patients were treated pharmacologically for newly developed atrial fibrillation. None of the patients needed hemodialysis. Transient neurological disorders were recorded in 10 (1.8%) of the patients. The early extubation failure group showed statistically significantly higher rates of preoperative lung dysfunction, use of extracorporeal circulation, administration of inotropic drugs in the operating room, and statistically significantly longer duration of surgery. CONCLUSION: Early extubation proved suitable as a routine procedure for the vast majority of patients. With a good postoperative analgetic protocol, there is no need for thoracic epidural analgesia. Such avoidance of thoracic epidural analgesia is a further step in minimizing invasiveness in cardiac surgery.
- MeSH
- časové faktory MeSH
- celková anestezie metody MeSH
- dospělí MeSH
- epidurální analgezie MeSH
- kardiochirurgické výkony metody MeSH
- koronární bypass MeSH
- lidé středního věku MeSH
- lidé MeSH
- odpojení od ventilátoru MeSH
- reoperace MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- srdeční chlopně chirurgie MeSH
- studie proveditelnosti MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
UNLABELLED: Authors describe the technique of anterior less invasive approach to the treatment of thoracolumbar spine. The advantage of the mentioned approach is the treatment of the anterior spinal column without opening the thoracic cavity. MATERIAL: In the period between 1996-2000 the described method was used in 46 patients. The average age of patients was 49 years (range, 22 to 67 years). There were 30 men and 16 women. Most frequently affected was L1-fractures in 29 patients, Th12 was handled in 16 patients and Th11 only in one case. METHOD: The surgical technique is based on the anterior approach to thoracolumbar spine without opening of the pleural cavity. RESULTS: The evaluation included 46 patients. The surgical time ranged between 100 minutes and 180 minutes. Blood losses ranged between 300 and 2000 ml. Pleural cavity was opened in three cases. Thoracic drainage was not applied in any patient from the followed-up group. Neither preoperative nor postoperative complications were recorded. In all cases allograft was used without complications. DISCUSSION: The described method is one of the possibilities of treating the anterior spinal column in the region of thoracolumbar spine in addition to the classic Hodgson approach or thoracoscopic treatment. CONCLUSION: In the given group of patients the authors' department introduced the treatment of the anterior column of thoracolumbar spine without opening pleural cavity and without the necessity of draining the thoracic cavity. It is a less invasive method as compared to the classic Hodgson approach. The alternative to the treatment of the anterior spinal column in the thoracolumbar region is the thoracoscopic method.
- MeSH
- bederní obratle chirurgie MeSH
- dospělí MeSH
- hrudní obratle chirurgie MeSH
- lidé středního věku MeSH
- lidé MeSH
- ortopedické výkony metody MeSH
- senioři MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
- MeSH
- fibrilace síní metabolismus MeSH
- lidé MeSH
- oxidační stres * MeSH
- revaskularizace myokardu škodlivé účinky MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- komentáře MeSH
- úvodníky MeSH
Longitudinal median sternotomy is even nowadays the standard approach to operations of the aortal valve. The authors summarize in the submitted paper their experience with operations in 60 patients where replacement of the aortal valve was performed either from a small transverse sternotomy in the second intercostal space or from upper ministernotomy from the jugulum to the fourth (third) intercostal space. One patient died. The low incidence of serious postoperative complications, the rapid rehabilitation of patients and short subsequent period of hospitalization indicate the advantages of this approach. The authors use at present upper ministernotomy as the surgical approach in the majority of operations of the aortal valve.
- MeSH
- aortální chlopeň chirurgie MeSH
- chirurgická náhrada chlopně metody MeSH
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- miniinvazivní chirurgické výkony metody MeSH
- senioři MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
- práce podpořená grantem MeSH
Trade plays a key role in the spread of alien species and has arguably contributed to the recent enormous acceleration of biological invasions, thus homogenizing biotas worldwide. Combining data on 60-year trends of bilateral trade, as well as on biodiversity and climate, we modeled the global spread of plant species among 147 countries. The model results were compared with a recently compiled unique global data set on numbers of naturalized alien vascular plant species representing the most comprehensive collection of naturalized plant distributions currently available. The model identifies major source regions, introduction routes, and hot spots of plant invasions that agree well with observed naturalized plant numbers. In contrast to common knowledge, we show that the 'imperialist dogma,' stating that Europe has been a net exporter of naturalized plants since colonial times, does not hold for the past 60 years, when more naturalized plants were being imported to than exported from Europe. Our results highlight that the current distribution of naturalized plants is best predicted by socioeconomic activities 20 years ago. We took advantage of the observed time lag and used trade developments until recent times to predict naturalized plant trajectories for the next two decades. This shows that particularly strong increases in naturalized plant numbers are expected in the next 20 years for emerging economies in megadiverse regions. The interaction with predicted future climate change will increase invasions in northern temperate countries and reduce them in tropical and (sub)tropical regions, yet not by enough to cancel out the trade-related increase.
- Klíčová slova
- alien vascular plants, bioinvasion, climate warming, global spread, imperialist dogma, model, network of plant invasion,
- MeSH
- biodiverzita MeSH
- distribuce rostlin * MeSH
- klimatické změny * MeSH
- obchod * MeSH
- rozvojové země * MeSH
- teoretické modely MeSH
- zavlečené druhy * MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
