Exclusion of an isolated iliac artery aneurysm using a bifurcated endograft following failed covered stent exclusion.

Endovascular exclusion with covered stents is an alternative to surgical repair of iliac artery aneurysms (IAAs). We report a case where covered stent implantation failed to exclude an IAA, as demonstrated by persistent endoleak. The aneurysm was successfully excluded with a bifurcated aortoiliac endograft.

New approach to preoperative vascular exclusion for carotid body tumor.

We report a new approach to preoperative vascular exclusion of a carotid body tumor. Before surgery, covered stents were placed in the external carotid artery, resulting in vascular exclusion of the tumor. Subsequent surgical excision was uneventful, with operative blood loss less than 200 mL and no neurologic complications postoperatively.

Descending necrotizing mediastinitis.

Descending necrotizing mediastinitis (DNM) is an infrequent clinical entity. DNM is the result of infection originating in the oropharyngeal regions and spreading along cervical fascial planes to cause mediastinal abscess and sepsis. Even with prompt recognition and treatment, the mortality and morbidity associated with DNM are appreciable.

Comparison of port access to sternotomy in tricuspid or mitral/tricuspid operations.

Background: Outcomes for a port-access (PA) approach for tricuspid valve operations have not been reported or compared to those using median sternotomy (MS).

Methods: Retrospective analysis was performed for 88 consecutive patients undergoing tricuspid valve repair or replacement using port-access techniques (n = 27, 1997-2000) versus sternotomy (n = 61, 1990-1997). PA procedures were performed through a 6 cm right fourth interspace thoracotomy.

Empyema complicating muscle-sparing thoracotomy: the role of wound management.

The fascial layers bordering the latissimus dorsi and anchoring the serratus muscles often do not lend themselves to impervious closure during muscle-sparing thoracotomy. Fluid from the subcutaneous space may therefore drain into the pleural cavity after such procedures. If this fluid is contaminated with microorganisms the potential for development of empyema is present.

Differences in length of stay between coronary bypass and valve procedures.

Objective: Emphasis on cost reduction, national standardization of medical care, and quality improvement initiatives have led to reduced postoperative hospital stays after cardiac surgery. The present study was designed to verify the observation that valve patients have longer lengths of stay than bypass patients and to identify possible reasons.

Methods: The inpatient records of 26 consecutive patients who underwent valve procedures at our institution were reviewed and compared with the records of 25 consecutive coronary bypass patients.