Design of transtibial mechanical prosthesis with feedback to ground irregularities

Abstract OBJECTIVES The aims of this study were to evaluate and compare the outcomes after pulmonary valve replacement (PVR) with a mechanical prosthesis (MP) and a bioprosthesis (BP). METHODS From 2004 through 2017, a total of 131 patients, who had already been repaired for tetralogy or Fallot or its variants, underwent their first PVR with an MP or a BP. Outcomes of interests were prosthesis failure (stenosis >3.5 m/s, regurgitation >mild or infective endocarditis) and reintervention. RESULTS The median age at PVR was 19 years. BP and MP were used in 88 (67.2%) and 43 (32.8%) patients, respectively. The median follow-up duration was 7.4 years, and the 10-year survival rate was 96.4%. Risk factors for prosthesis failure were smaller body surface area [hazard ratio (HR) 0.23 per 1 m2, P = 0.047] and smaller prosthesis size (HR 0.73 per 1 mm, P = 0.039). Risk factors for prosthesis reintervention were smaller body surface area (HR 0.11 per 1 m2, P = 0.011) and prosthesis size (HR 0.67 per 1 mm, P = 0.044). Probability of prosthesis failure and reintervention at 10 years were 24.6% (19.5% in BP vs 34.8% in MP, P = 0.34) and 7.8% (5.6% in BP vs 11.9% in MP, P = 0.079), respectively. Anticoagulation-related major thromboembolic events were observed in 4 patients receiving an MP. CONCLUSIONS MP might not be superior to BP in terms of prosthesis failure or reintervention. MP should be carefully considered for highly selected patients in the era of transcatheter PVR.

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Minimally invasive redo aortic valve replacement with a sutureless valve implant

10.1510/mmcts.2021.008 ◽

2021 ◽

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Minimally Invasive ◽

Valve Replacement ◽

Valve Prosthesis ◽

Mechanical Prosthesis ◽

Invasive Approach ◽

Replacement Procedure ◽

Aortic Valve Prosthesis ◽

Sutureless Valve

Reoperations for a dysfunctional mechanical aortic valve prosthesis are usually performed with a repeat sternotomy. Reopening the chest may be associated with a heart structure tear, bleeding, excessive transfusion, and a possible unfavorable outcome. Experience performing a redo aortic valve replacement with a minimally invasive approach and avoiding lysis of the pericardial adhesions is growing. We describe a redo aortic valve replacement procedure performed because of subvalvular pannus formation in a patient with a mechanical prosthesis. A partial J-shaped hemisternotomy at the 3rd intercostal space was performed; the ascending aorta was exposed and the valve was replaced with a sutureless bioprosthesis. The video tutorial shows the surgical approach, cardiopulmonary bypass solutions, and sutureless valve deployment.

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Writing with new hands

Nowa Kodyfikacja Prawa Karnego ◽

10.19195/2084-5065.44.11 ◽

2017 ◽

Vol 44 ◽

pp. 135-145

Author(s):

Walter Brandner

Keyword(s):

Mechanical Prosthesis ◽

Physical Conditions ◽

Difficult Situations ◽

The Brain

To analyse and compare the handwriting of a person under different circumstances — with origin hands, with a mechanical prosthesis and with new transplanted hands — it is necessary to have some information about the physical conditions. The handwriting of Theo Kelz proves that the writing is controlled by the brain. This leads to the conclusion that also under very difficult situations a forensic comparison of handwritings is possible.

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A Patient with Giant Left Atrium Undergoes Orthotopic Heart Transplantation

Texas Heart Institute Journal ◽

10.14503/thij-12-2948 ◽

2014 ◽

Vol 41 (1) ◽

pp. 87-90 ◽

Cited By ~ 2

Author(s):

Sergey Y. Boldyrev ◽

Murat K. Lepshokov ◽

Igor I. Yakuba ◽

Kirill O. Barbukhatty ◽

Vladimir A. Porhanov

Keyword(s):

Left Atrium ◽

Left Atrial ◽

Left Atrial Volume ◽

Posterior Wall ◽

Orthotopic Heart Transplantation ◽

Mechanical Prosthesis ◽

Size Mismatch ◽

Giant Left Atrium ◽

Left Atrial Posterior ◽

Rheumatic Heart

We present a novel technique for resolving the problem of radical size mismatch at the time of orthotopic transplantation. A 48-year-old man presented with chronic rheumatic heart disease and a giant left atrium. Twenty-three years before, he had undergone mitral valve replacement with a mechanical prosthesis. At the time of the repeated intervention, the volume of his left atrium was 350 mL. Surgical features of the transplantation included approximation of the pulmonary vein ostia by gathering sutures intentionally, in order to decrease the area of the left atrial posterior wall and thereby enable appropriate coaptation with the donor left atrium. After the operation, left atrial volume had been reduced to 60 mL.

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Specific diseases: valvular heart disease

ESC CardioMed ◽

10.1093/med/9780198784906.003.0641 ◽

2018 ◽

pp. 2666-2667

Author(s):

Bernard Iung ◽

Luc A. Pierard

Keyword(s):

Cardiac Surgery ◽

Aortic Stenosis ◽

Perioperative Complications ◽

Left Ventricular ◽

Valvular Disease ◽

Left Ventricular Ejection ◽

Mechanical Prosthesis ◽

Ventricular Ejection Fraction ◽

Asymptomatic Patients ◽

Mitral Commissurotomy

The evaluation of the risk of non-cardiac surgery in patients with valvular disease should take into account the type, severity, and tolerance of valvular disease, and the risk inherent to non-cardiac surgery. Aortic stenosis carries the highest risk of perioperative complications. Except for emergency non-cardiac surgery, an intervention on the aortic valve is indicated firstly in case of severe symptomatic aortic stenosis. In asymptomatic patients, low- and intermediate-risk non-cardiac surgery can be performed, while the strategy should be individualized for high-risk non-cardiac surgery. Balloon aortic valvuloplasty may be used as a bridge if non-cardiac surgery is urgent. Percutaneous mitral commissurotomy should be considered in symptomatic patients with severe mitral stenosis. In patients with severe aortic or mitral regurgitation, the risk of non-cardiac surgery is low if they are asymptomatic with preserved left ventricular ejection fraction. In patients with a mechanical prosthesis, perioperative anticoagulant therapy should be adapted to the haemorrhagic risk of intervention and to the patient- and prosthesis-related thromboembolic risk.

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In patients undergoing dialysis who require a valve replacement is a bioprosthetic valve superior to a mechanical prosthesis in terms of long-term survival and morbidity?

Interactive Cardiovascular and Thoracic Surgery ◽

10.1093/icvts/ivaa084 ◽

2020 ◽

Vol 31 (2) ◽

pp. 174-178

Author(s):

Laura S Fong ◽

Zhen Hao Ang ◽

Hugh Wolfenden ◽

Zakir Akhunji

Keyword(s):

Valve Replacement ◽

Mechanical Valve ◽

High Risk Group ◽

Bioprosthetic Valve ◽

Valve Prosthesis ◽

Mechanical Prosthesis ◽

Term Survival ◽

Long Term Survival ◽

Significant Difference

Abstract A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was ‘In [dialysis patients undergoing a valve replacement] is [a bioprosthetic valve superior to a mechanical prosthesis] for [long-term survival and morbidity]’. Altogether more than 501 papers were found using the reported search, of which five represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. There was limited high-quality evidence with all studies being retrospective. One meta-analysis and four cohort studies provided the evidence that there was no significant difference in long-term survival based on prosthesis type. However, the majority of studies demonstrated a significantly higher rate of valve-related complications including bleeding and thromboembolism, and readmission to hospital in the mechanical valve prosthesis group, likely related to the requirement for long-term anticoagulation. We conclude that overall long-term survival in dialysis-dependent patients is poor. While prosthesis type does not play a significant contributing role to long-term survival, bioprosthetic valves were associated with significantly fewer valve-related complications. Based on the available evidence, a bioprosthetic valve may be more suitable in this high-risk group of patients as it may avoid the complications associated with long-term anticoagulation without any reduction in long-term survival.

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Aortic valve replacement by mechanical prosthesis in children: A positive long-term outcome including for patients with an infantile Marfan syndrome

Archives of Cardiovascular Diseases Supplements ◽

10.1016/j.acvdsp.2018.10.306 ◽

2019 ◽

Vol 11 (1) ◽

pp. 137-138

Author(s):

A. Moreau de Bellaing ◽

O. Raisky ◽

A. Haydar ◽

D. Bonnet ◽

F. Bajolle

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Marfan Syndrome ◽

Valve Replacement ◽

Mechanical Prosthesis ◽

Term Outcome ◽

Long Term Outcome

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Dacron Patch Closure of Ventricular Septal Defect with Concomitant Aortic Valve Replacement using a Mechanical Prosthesis: A Video Presentation

Journal of Cardiac Critical Care TSS ◽

10.1055/s-0040-1709271 ◽

2019 ◽

Vol 3 (02) ◽

pp. 099-100

Author(s):

Ujjwal Kumar Chowdhury ◽

Niwin George ◽

Sukhjeet Singh ◽

Poonam Malhotra Kapoor ◽

Lakshmi Kumari Sankhyan ◽

...

Keyword(s):

Aortic Valve ◽

Ventricular Septal Defect ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Septal Defect ◽

Mechanical Prosthesis ◽

Jude Medical ◽

Technical Details ◽

Patch Closure ◽

Dacron Patch

AbstractWe performed Dacron patch closure of ventricular septal defect with concomitant aortic valve replacement using a St. Jude Medical mechanical aortic prosthesis for a patient with ventricular septal defect and severely deformed and irreparable aortic valve. We highlight the technical details of the procedure to prevent paravalvular aortic leakage and residual ventricular septal defect.

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