Minimally invasive aortic valve replacement: late conversion to full sternotomy doubles operative time.

In this descriptive prospective study, we evaluate the outcomes of surgery in 98 patients who were scheduled to undergo minimally invasive aortic valve replacement. These patients were compared with a group of 50 patients who underwent scheduled aortic valve replacement through a full sternotomy. The 30-day mortality rate for the 98 patients was zero, although 14 of the 98 mini-sternotomies had to be converted to complete sternotomies intraoperatively due to technical problems.

TachoSil surgical patch versus conventional haemostatic fleece material for control of bleeding in cardiovascular surgery: a randomised controlled trial.

Objective: Prolonged bleeding during cardiovascular surgery presents a risk for the patient and increases the time and cost of surgery. TachoSil is a ready-to-use haemostatic agent that consists of an equine collagen patch coated with human fibrinogen and thrombin. This trial evaluated the efficacy and safety (< or =30 days post-surgery) of TachoSil surgical patch compared with standard haemostatic fleece for the control of bleeding in patients undergoing cardiovascular surgery.

Minimally invasive aortic valve replacement reduces atelectasis in cardiac intensive care.

Objective: Respiratory failure is a major complication after cardiac surgery. The purpose was to evaluate the impact of minimally invasive aortic valve replacement (mini AVR) on the occurrence of left lower lobe atelectasis (LLLA) in the cardiac intensive care unit (ICU).

Patients And Methods: 98 patients were scheduled to undergo mini AVR.

[Total remission of hemiparesis after operation in acute aortic dissection].

Cerebral ischaemia might not preclude operation in acute aortic dissection. A 37-year-old male with an acute proximal aortic dissection (type A) and coma and hemiparesis caused by involvement of the arch vessels and secondary brain malperfusion underwent emergency surgical repair with replacement of the ascending aorta in profound circulatory arrest. The patient recovered fully and was asymptomatic and in good health two years after the operation.

[Aortic homograft implantation in severe endocarditis].

Introduction: Severe endocarditis of the native aortic valve or a prosthetic valve with destruction of the cusps, paravalvular abscess formation and/or fistulas caused by aggressive bacteria has a mortality of almost 100% without surgery. The objective was to evaluate the results of treatment with an aortic homograft in combination with antibiotics.

Materials And Methods: 24 patients with either aortic prosthetic valve endocarditis (n = 16) or severe aortic endocarditis (n = 8) were operated with implantation of an aortic homograft at a Danish university hospital from 1997-2006.

Outcome of aortic homograft implantation in 24 cases of severe infective endocarditis.

The objective of the study was to evaluate the results of treatment of severe aortic endocarditis with an aortic homograft (an aortic valve and root from a donor) in combination with antibiotic therapy. 24 patients with either aortic prosthetic valve endocarditis (n=16) or severe aortic native valve endocarditis (n=8) with destruction of 1 or more cusps, paravalvular abscess formation and/or cardiac fistulas caused by aggressive bacteria, underwent surgery in 1997-2006. Staphylococcal species were the most common pathogens followed by streptococci.

Coronary artery bypass grafting within the first year after treatment of large acute myocardial infarctions with angioplasty or fibrinolysis.

Objectives: To calculate the incidence and analyse and outcome after coronary artery bypass grafting (CABG) within the first year after randomisation of 1,572 patients with acute myocardial infarctions with ST-segment elevation (STEMI) to either percutaneous coronary intervention (PCI) or fibrinolysis.

Design: The study includes 131 patients: 108 male and 23 female with a mean age 62 years.

Results: The total 30-day mortality after CABG was 4.

An update on internal mammary artery grafting for coronary artery disease.

Purpose Of Review: To describe recent results regarding the use of the internal mammary artery for coronary artery bypass grafting with emphasis on bilateral internal mammary artery grafting, patency, resistance to atherosclerosis, skeletonisation, composite arterial grafts, flow measurement, vasodilatation, and non-invasive imaging techniques.

Recent Findings: Coronary artery bypass grafting plays an important part in coronary revascularisation and seems to be associated with a survival benefit in comparison with percutaneous coronary intervention. After 10 years, internal mammary arteries demonstrate better patency than vein grafts except when grafting moderately stenosed right coronary arteries.

Baseline flow in coronary bypass grafts.

Background: The purpose of the study is to estimate the total blood flow in coronary artery bypass grafts.

Methods: In a 3-year period 102 patients having a standardized coronary artery bypass grafting (CABG) with the left internal mammary artery (LIMA) anastomosed to the left anterior descending artery and a sequential vein grafted to the remaining diseased coronary arteries were included in the study, 21 females and 81 males. In females a mean of 3.

Flow in coronary bypass conduits on-pump and off-pump.

Background: The purpose of the study was to measure the blood flow in coronary artery bypass grafting conduits on-pump and off-pump and to estimate the total conduit flow.

Methods: In a 3.5-year period, 120 patients having coronary artery bypass grafting on-pump and 97 patients having coronary artery bypass grafting off-pump with the left internal mammary artery anastomosed to the left anterior descending artery and saphenous vein grafts to the remaining diseased coronary arteries were included in the study.

Coronary artery bypass grafting within 30 days after treatment of acute myocardial infarctions with angioplasty or fibrinolysis - a surgical substudy of DANAMI-2.

Objective: To calculate the incidence and analyse the indications and outcome after surgical revascularization within the first 30 days after randomization of 1572 patients with acute myocardial infarction (MI) associated with ST-segment elevation (STEMI).

Design: Data regarding the patients undergoing heart surgery within the first 30 days after randomization were collected.

Results: Three patients (0.

Patient-derived fibrin sealant: clinical, preclinical, and biophysical aspects.

Today, there is an enormous interest in surgical sealant, not only for hemostasis, but also for binding of tissues together during surgery, and to improve wound healing. Man has imitated nature in developing fibrin sealant that is biodegradable. However, the risk of transmission of both known and unknown infectious agents can generally not be ruled out completely for plasma products from donors.

A comparison of coronary angioplasty with fibrinolytic therapy in acute myocardial infarction.

Background: For the treatment of myocardial infarction with ST-segment elevation, primary angioplasty is considered superior to fibrinolysis for patients who are admitted to hospitals with angioplasty facilities. Whether this benefit is maintained for patients who require transportation from a community hospital to a center where invasive treatment is available is uncertain.

Methods: We randomly assigned 1572 patients with acute myocardial infarction to treatment with angioplasty or accelerated treatment with intravenous alteplase; 1129 patients were enrolled at 24 referral hospitals and 443 patients at 5 invasive-treatment centers.

A comparison of the haemostatic effect of Vivostat patient-derived fibrin sealant with oxidised cellulose (Surgicel) in multiple surgical procedures.

Aim: To evaluate the haemostatic properties of Vivostat patient-derived fibrin sealant in a broad range of surgical procedures.

Method: In a prospective, randomised, multicentre, clinical study, typical surgical wounds of 69 patients (cardiothoracic, general, obstetric and gynaecologic, and vascular), requiring intervention to control bleeding, were treated with either Vivostat-derived sealant (n = 35) or Surgicel (n = 34) as required and the time taken to arrest bleeding was assessed.

Results: Compared with Surgicel, the mean time to haemostasis of Vivostat-derived sealant was significantly shorter (1.

Suture support: is it advantageous?

Sutures have been used to facilitate and enhance wound closure and healing throughout the course of medical history. Suturing is still the most common method of wound closure, but in some surgical situations suture support can improve clinical outcomes. Sutures provide mechanical support to a wound and help create the optimal environment for wound healing.

Development of a model for measurement of adhesion strength of fibrin sealant to human tissue.

It is crucial for the surgeon to know the physical properties of a surgical sealant. Current test methods of fibrin sealant involving animal testing or in vitro testing of sealant using artificial substrates have little clinical relevance. Most of these test methods also lack accuracy and reproducibility.

Bleeding from the sternal marrow can be stopped using vivostat patient-derived fibrin sealant.

Background: Median sternotomy is the most important method of access to the heart. Bleeding from the sternal marrow may become significant, especially in elderly patients. Vivostat (ConvaTec, a Bristol-Myers Squibb Company, Skillman, NJ) patient-derived fibrin sealant is biocompatible and easily applied to the sternal marrow using the Vivostat Spraypen applicator.

Prevention of air leakage by spraying vivostat fibrin sealant after lung resection in pigs.

Study Objectives: To evaluate Vivostat fibrin sealant in the prevention of air leakage after experimental lung resection in pigs.

Design: Randomized study.

Setting: University laboratory.

Comparative kinetics of polymerisation of three fibrin sealants and influence on timing of tissue adhesion.

The clinical performance of fibrin sealants may be influenced by physical properties such as elasticity, tensile strength, and ability to adhere to human tissue. These properties are related to the internal structure of the fibrin sealant that builds as it polymerises. Analysis of the minimum polymerisation time to achieve a functional fibrin clot is clinically important.

Intraluminal papaverine with pH 3 doubles blood flow in the internal mammary artery.

Seventy-five patients undergoing coronary artery bypass grafting were randomized to receive injections of papaverine solution or isotonic saline or no injection into the left internal mammary artery (LIMA) used as graft. Blood flow in the LIMA was measured twice-after dissection of the pedicle and before anastomosis to the coronary artery. Blood flow increased significantly in all three groups, but after papaverine injection it was twice as high as in the control groups, increasing by 285% (from 40 +/- 12 to 154 +/- 32 ml/min, p = < 0.

Severe impairment of graft flow without electrocardiographic changes during coronary artery bypass grafting.

Early graft occlusion after coronary artery bypass grafting may have deleterious consequences. We routinely use transit-time flowmetry after termination of cardiopulmonary bypass, and we report five cases of early graft failure detected by the flowmeter. Electrocardiographic (ECG) changes were seen in only one of these five cases, and none of the patients had low cardiac output or other signs of graft failure at the end of the operation.

Recurrent endocarditis in silver-coated heart valve prosthesis.

Background And Aim Of The Study: In order to prevent prosthetic valve endocarditis (PVE), the implantation of a new silver-coated sewing ring has been introduced to provide peri- and postoperative protection against microbial infection.

Methods: A 56-year-old woman with aortic stenosis had elective replacement with a St. Jude Medical mechanical valve fitted with a silver-coated sewing ring (Silzone).

[Coronary bypass surgery using the radial artery. An alternative in patients with varicose veins].

Arterial revascularization of the heart with the radial artery was performed in twenty patients with varicosities of the lower legs. The patients all had a good functional result and were free of angina pectoris after the operation. None of the patients had complications from harvest of the radial artery.

[Cardiac revascularization using both mammary arteries].

Both internal mammary arteries in combination with veins were used for revascularization of the hearth in fifty Danish patients undergoing coronary artery bypass grafting (CABG) at Gentofte Hospital during the period 1994-1996. Patients with insulin-dependent diabetes mellitus, obesity, and age over 75 years were excluded. The patients were followed for at least one month after the operation.