Transvenous Implantation of a Stent Valve in Patients With Degenerated Mitral Prostheses and Native Mitral Stenosis.

Background: The purpose of this study was to report the use of a transvenous transseptal approach using a stent valve in patients with degenerated biological mitral valve prostheses, regurgitation after mitral repair, and native mitral stenosis.

Methods: Ten patients (median age, 74 years; range, 20-89 years; 5 men and 5 women) with degenerated mitral bioprosthetic valves (n = 7), failed mitral repair (n = 1), or calcified native stenotic valves (n = 2) underwent transvenous implantation of a stent valve.

Results: The procedure was initially successful in all patients.

Lymphocyte subpopulations in lymph nodes and peripheral blood: a comparison between patients with stable angina and acute coronary syndrome.

Objective: Atherosclerosis is characterized by a chronic inflammatory response involving activated T cells and impairment of natural killer (NK) cells. An increased T cell activity has been associated with plaque instability and risk of acute cardiac events. Lymphocyte analyses in blood are widely used to evaluate the immune status.

Collagen-gentamicin implant for prevention of sternal wound infection; long-term follow-up of effectiveness.

In a previous randomized controlled trial (LOGIP trial) the addition of local collagen-gentamicin reduced the incidence of postoperative sternal wound infections (SWI) compared with intravenous prophylaxis only. Consequently, the technique with local gentamicin was introduced in clinical routine at the two participating centers. The aim of the present study was to re-evaluate the technique regarding the prophylactic effect against SWI and to detect potential shifts in causative microbiological agents over time.

Impella used for hemostasis by left ventricular unloading, in a case with left ventricular posterior wall rupture.

Left ventricle wall rupture is a feared complication in mitral valve surgery. We report a combined mitral valve anuloplasty and coronary artery bypass grafting procedure with severe, life-threatening bleeding complication due to left ventricular posterior wall rupture. The patient was successfully treated with a temporary left ventricular assist device to decompress the left ventricle in an attempt to minimize the bleeding, as the patient's condition did not allow standard repair of the left ventricle.

The Linköping experience--ups and downs.

This is a brief single-centre report of experiences regarding different prophylactic measures against sternal wound infection during a period of about 10 years. It illustrates the difficulties associated with evaluating the effect of specific prophylactic methods in the clinical situation. Possible explanations for perceived shifts in the rate of wound infections are discussed.

Wound contamination in cardiac surgery. A systematic quantitative and qualitative study of the bacterial growth in sternal wounds in cardiac surgery patients.

Objectives: To investigate the degree of bacterial contamination in the sternal wound during cardiac surgery and the sternal skin flora after operation in order to increase our understanding of the pathogenesis of sternal wound infections.

Design: Prospective study where cultures were taken peri- and postoperatively from sternal wounds and skin.

Setting: University Hospital.

A multimodal approach for reducing wound infections after sternotomy.

As previous efforts failed to reduce infection rates after cardiac surgery at our institution, we developed a concept based on adjustment of surgical technique. This concept was then evaluated in clinical practice. We modified our surgical technique towards: minimizing contamination, avoidance of devitalizing tissue, and securing a rigid fixation of the caudal part of sternum.

Cost effectiveness of local collagen-gentamicin as prophylaxis for sternal wound infections in different risk groups.

Objectives: In a randomized trial addition of local collagen-gentamicin in the sternal wound reduced the rate of sternal wound infection (SWI) to about 50% compared to intravenous prophylaxis alone. The aim of the present study was to evaluate the economic rationale for its use in every-day clinical practice. This includes the question whether high-risk groups that may have particular benefit should be identified.