Supraclavicular Subclavian access for Sapien Transcatheter aortic valve replacement- a novel approach.

Background: Within the trans-subclavian approach, procedural techniques can vary widely, and reported access generally refers to an infraclavicular axillary approach. We describe and report the use of a novel supraclavicular true subclavian approach for transcatheter aortic valve replacement (TAVR) exclusively for implantation of Sapien 3 valves.

Case Presentation: We report our first five consecutive patients undergoing TAVR with a Sapien 3 valve using a standardized subclavian approach at a single center.

Trends in aortic valve surgery in a large multi-surgeon, multi-hospital practice, 1979-1999.

Background And Aim Of The Study: Trends in aortic valve operations (AVO) may help to predict the future of aortic valve surgery in the context of changing case mix, population demographics, emerging technology and shifting paradigms.

Methods: All adults undergoing single AVO between 1979 and 1999 were reviewed retrospectively according to age, gender and other typical clinical variables, surgical complexity, specific operation and immediate outcome.

Results: There were 3,917 single AVO.

Reflux in untreated achalasia patients.

We made a prospective assessment of acid exposure in the distal esophagus in 48 consecutive untreated patients with achalasia using 24-h ambulatory esophageal pH studies. The majority of patients (38/48) experienced reflux that was within reported values for normal controls (total time pH < 4.0, 1.

Cerebral pressure-flow relationship during cardiopulmonary bypass in the dog at normothermia and moderate hypothermia.

We studied cerebral autoregulation by analyzing cerebral pressure-flow curves during cardiopulmonary bypass (CPB) with alpha-stat (alpha-stat) acid-base management at 28 (n = 9) and 37 degrees C (n = 9) in two groups of dogs. Cerebral blood flow (CBF) and cerebral metabolic rate for oxygen (CMRO2) were determined multiple times in each animal over an extensive range of cerebral perfusion pressure (CPP). The CPP was altered by changing perfusion flow rate.

Paraplegia following thoracic aortic cross-clamping in dogs. No difference in neurological outcome with a barbiturate versus isoflurane.

Background And Purpose: We compared the incidence and severity of paraplegia following thoracic aortic cross-clamping in dogs for two anesthetic regimens. Animals were randomly assigned to receive methohexital (group M; n = 9) or isoflurane (group I; n = 9). We expected a better neurological outcome in animals administered methohexital because of superior neuronal protection and greater spinal cord perfusion pressure (mean arterial pressure below the cross-clamp site minus mean cerebrospinal fluid pressure).

Treatment of proximal aortic hypertension after thoracic aortic cross-clamping in dogs. Phlebotomy versus sodium nitroprusside/isoflurane.

Thoracic aortic cross-clamping causes proximal aortic hypertension. Theoretically, the method used to treat hypertension can influence spinal cord perfusion pressure and neurologic outcome. Phlebotomy was compared to sodium nitroprusside/isoflurane in terms of ability to treat increased proximal mean aortic pressure (MAPp) after thoracic aortic cross-clamping in dogs.

Phlebotomy reverses the hemodynamic consequences of thoracic aortic cross-clamping: relationships between central venous pressure and cerebrospinal fluid pressure.

In dogs (n = 11) anesthetized with sodium pentobarbital (to an isoelectric EEG), the authors investigated the influence of thoracic aortic cross-clamping (AXC) on systemic hemodynamics and cerebrospinal fluid pressure (CSFP) with concurrent measurement of total brain flow (tCBF) and regional (cervical, thoracic, and lumbar) spinal cord blood flow (SCBF). The effect of phlebotomy (to control the hemodynamic consequences of AXC) on tCBF and SCBF was assessed. Radioactive microspheres were injected at four time periods in each animal: 1) at baseline; 2) with application of the AXC; 3) after phlebotomy, to reduce the proximal mean arterial pressure (MAPp) to baseline values; and 4) 2 min after removal of the AXC (mean AXC time 68 +/- 6 min).

Esophageal reflux before and after isolated myotomy for achalasia.

Four patients with achalasia underwent 24-hour esophageal pH measurements as ambulatory patients before and after limited myotomy without fundoplication. Resting lower esophageal sphincter pressure was reduced from 24.3 +/- 1.

Intrathoracic meningocele associated with neurofibromatosis: case report.

The authors present a case of intrathoracic meningocele associated with neurofibromatosis. Computed tomography with metrizamide myelography proved valuable in locating the lesion, thus facilitating surgical intervention. With the preoperative diagnosis established and the severity of the meningocele known, the surgeons safely employed a subpleural approach at thoracotomy.

Bjork-Shiley cardiac valves long term results: Winnipeg experience.

Between April 1970 and December 1984, 1183 Bjork-Shiley cardiac valve prostheses were implanted in 915 patients (470 males, 445 females). Four types of valves were used; Delrin disc prostheses in 75 patients, pyrolytic carbon spherical disc valves in 645 patients, the 60 degrees convexo-concave disc model in 197 patients and the 70 degrees model in seven patients. Isolated mitral valve replacement was performed in 278 patients, isolated aortic valve replacement in 363 and double valve replacement in 153.

Reflux patterns in patients with achalasia without operation.

Five patients with achalasia who had not had an operation underwent esophageal manometry and 24-hour, ambulatory pH monitoring to determine the pattern and extent of esophageal reflux. One patient had reflux within normal limits. In 2 patients, reflux occurred 0.

Reflux patterns following limited myotomy without fundoplication for achalasia.

Five patients with achalasia underwent limited myotomy without fundoplication. Surgery reduced mean lower esophageal sphincter resting pressure significantly (p less than .05) from 31 +/- 9.

Atypical manifestations of pulmonary adenoid cystic carcinoma.

Pulmonary adenoid cystic carcinoma (PACC) typically arises in large airways. A patient who presented with a peripheral lung mass due to PACC is reported. She was found to have multiple pulmonary nodules due to PACC 11 years after resection of the original tumour.

Surgical management of recurrent spontaneous pneumothorax during pregnancy.

We report three cases of recurrent spontaneous pneumothorax associated with pregnancy. All three cases had apical bullectomies during their pregnancies.

Risks and benefits of open-heart surgery in patients 70 years of age and older.

From January 1978 to December 1982, 165 consecutive patients aged 70 to 81 years underwent various open-heart surgical procedures at the St. Boniface General Hospital in Winnipeg. Preoperatively, most of the patients were in functional class III or IV (New York Heart Association classification).