Surgical Treatment of Double Valve Endocarditis

2014 ◽  
Vol 17 (1) ◽  
pp. 28
Author(s):  
Serpil Tas ◽  
Taylan Adademir ◽  
Eylem Yayla Tuncer ◽  
Arzu Antal Donmez ◽  
Ebru Bal Polat ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Aortic Valve ◽  
Survival Rates ◽  
Pacemaker Implantation ◽  
Prosthetic Valve Endocarditis ◽  
Actuarial Survival ◽  
Mortality And Morbidity ◽  
Septic Embolization ◽  
The Mean

<p><b>Background:</b> We have retrospectively analyzed the results of the operations made for aortic infective endocarditis with mitral involvement in a single center in 19 years.</p><p><b>Methods:</b> From May 1992 to January 2011, we have operated on 72 patients with infective endocarditis of the aortic valve with mitral valve involvement. Fifty-two patients (72.2%) were male and the mean age was 40.5 � 15.5 (9-73) years. The blood cultures were positive in 33 patients (45.8%) and the most commonly identified microorganism was Streptococcus. Nine patients (12.5%) had prosthetic valve endocarditis. The mean duration of follow-up was 6.8 � 4.7 (0.1-16.9) years, adding up to a total of 156.1 patient/years.</p><p><b>Results:</b> A total of 155 procedures were performed on these 72 patients. The most commonly performed procedure was aortic valve replacement, in 63 patients (87.5%). Aortic annular involvement was present in 9 cases (12.5%). In-hospital mortality was seen in 13 patients (18.1%). Postoperatively, 13 (18.1%) patients had low cardiac output, 9 (12.5%) had heart block, and only 1 of them required permanent pacemaker implantation. The actuarial survival rates for 1, 5, and 10 years were 96.4% � 2.5%, 84.4% � 5.1%, and 77.4 � 6.7%, respectively.</p><p><b>Conclusions:</b> Double-valve endocarditis is a serious condition and the surgeon must be aware of the high rates of mortality and morbidity in these patients. Although no association was found, heart blocks and septic embolization must be handled with caution. The patients generally do well after surgery, and recurrences and reoperations decrease by the second year after operation.</p>

Bifurcated bypass in severe chronic limb threatening ischaemia

Vascular ◽  
2021 ◽  
pp. 170853812199985
Author(s):  
Daniele Adami ◽  
Michele Marconi ◽  
Alberto Piaggesi ◽  
Davide M Mocellin ◽  
Raffaella N Berchiolli ◽  
...  
Keyword(s):  
Survival Rates ◽  
Primary Patency ◽  
Free Survival ◽  
Mortality And Morbidity ◽  
Bypass Patency ◽  
Stage 4 ◽  
Endovascular Approach ◽  
The Mean ◽  
Clinical Records

Objectives Revascularization according to the angiosome concept is of proven importance for limb salvage in chronic limb threatening ischaemia but it is not always practicable. Bifurcated bypasses could be considered as an option when an endovascular approach is not feasible or has already failed and a single bypass would not allow direct revascularization of the ischaemic area. Bifurcated bypasses are characterized by landing on two different arteries, the main artery (in direct continuity with the foot vessels) and the secondary one (perfusing the angiosome district). The aim of this study is to evaluate the safety and effectiveness of bifurcated bypass in chronic limb threatening ischaemia. Methods Thirty-five patients were consecutively treated with a bifurcated bypass for chronic limb threatening ischaemia from January 2014 to December 2019 in a single vascular surgery centre. Data from clinical records and operative registers were collected prospectively in an electronic database and retrospectively analysed. Primary and primary assisted bypass patency, amputation-free survival, morbidity and mortality rates at 12 and 24 months were analysed. Results Mean follow-up period was 25.1 months (range 2–72 months). Thirty-six bifurcated bypasses were performed on 35 patients (age 75.3 ± 7.2 years; 69.4% were male). According to Wound, Ischemia, foot Infection classification 22.2% belonged to stage 3 and 77.8% to stage 4 and the mean Rutherford’s class was 5.1 ± 0.7. Immediate technical success was 100%. Early mortality and morbidity rates were respectively 5.5%, and 33.3%; foot surgery was performed in 50% of cases with wound healing in all patients. Primary patency and primary assisted bypass patency were 96.7% and 100% at 6 months; 85.2% and 92% at 12 months, 59.9% and 73.4% at 24 months, respectively. Amputation-free survival at 12 and 24 months was, respectively, 95.6% and 78.8%. Overall survival rates at 12 and 24 months were respectively 94.4% and 91.6%. Conclusions Bifurcates bypass can provide good results in patients with chronic limb threatening ischaemia without endovascular option, especially in diabetic ones. Bifurcated bypass is a complex surgical solution, both to be planned and performed, and it is quite invasive for frail patients that should be accurately selected.

Outcomes of patients with acute prosthetic aortic valve endocarditis

2020 ◽  
pp. 021849232097411 ◽  
Author(s):  
Pietro Giorgio Malvindi ◽  
Carlo Olevano ◽  
Suvitesh Luthra ◽  
Geoffrey Tsang ◽  
Clifford Barlow ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Hospital Mortality ◽  
Medical Treatment ◽  
Prosthetic Valve Endocarditis ◽  
Early Death ◽  
Surgical Mortality ◽  
Mortality And Morbidity ◽  
Prosthetic Aortic Valve ◽  
Kaplan Meier

Background Prosthetic valve endocarditis is burdened by high mortality and morbidity. We reviewed our experience in the management of patients with acute prosthetic aortic valve infection and studied the implications and outcomes associated with surgical treatment and medical therapy. Methods Data of 118 consecutive patients admitted during the period 2008–2018 with definite acute prosthetic aortic valve endocarditis, and presenting a surgical indication, were retrieved from the hospital database. Univariate and multivariate analysis were undertaken to study the association of preoperative characteristics with hospital mortality and the probability of undergoing a reoperation. Survival was assessed with Kaplan-Meier analysis. Results In the overall population, prosthesis dehiscence was independently associated with the possibility of undergoing surgical reoperation, while presentation with embolic stroke was associated with medical treatment. Hospital mortality was 24%, medical treatment was found to be independently associated with early death. One hundred (85%) patients underwent redo procedures; aortic valve replacement was performed in 53 and full root replacement in 47. Postoperative hospital mortality was 17%. Survival at 1-, 5-, and 8-years was 78%, 74%, and 66%, respectively. Freedom from reoperation and recurrent endocarditis was 95% at 8-year follow-up. Hospital mortality in patients who did not receive a redo operation was 61% with a survival rate of 17% at 1-year follow-up. Conclusions Surgical mortality after reoperation for prosthetic aortic valve endocarditis is still high but mid-term outcomes are satisfactory. Failure to undertake surgery when indicated is an independent risk factor for early death.

Intermediate Outcomes after Rapid Deployment Aortic Valve Replacement in Multiple Valve Surgery

2019 ◽  
Vol 68 (07) ◽  
pp. 595-601
Author(s):  
Markus Schlömicher ◽  
Matthias Bechtel ◽  
Zulfugar Taghiyev ◽  
Hamid Naraghi ◽  
Peter Lukas Haldenwang ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Valve Surgery ◽  
Actuarial Survival ◽  
Intermediate Outcomes ◽  
The Mean ◽  
Rapid Deployment

Abstract Background Multiple valve surgery is associated with significant higher operative risks. Reduced cross-clamp and cardiopulmonary bypass times in multiple valve surgery may potentially be beneficial as they can be considered independent risk factors for increased morbidity and mortality following cardiac surgery. We report first intermediate outcomes of the Edwards Intuity valve system (Edwards Lifesciences, Irvine, California, United States) in combined procedures Methods Fifty-eight patients underwent rapid deployment aortic valve replacement with concomitant mitral valve surgery between January 2014 and November 2017 in our institution. The valve was assessed echocardiographically after 12 months. The median follow-up was 1.7 years with a cumulative follow-up time of 115.3 patient years. Results The mean age was 73.5 ± 6.2 years and the mean logistic Euroscore was 11.6 ± 3.1%. Concomitant mitral valve repair was performed in 43 cases (74.1%), and mitral valve replacement in 15 cases (19.0%). The mean cross-clamp time was 93 ± 21 minutes along with a mean bypass time of 118 ± 24 minutes. All-cause mortality after 30 days was 8.6%. Overall actuarial survival at 1 year was 87.2 ± 4.5% and after 2 years 82.8 ± 5.3%, respectively. Conclusions Rapid deployment aortic valve replacement in multiple valve surgery can be performed safely with good intermediate outcomes in elderly, high-risk patients.

Survival benefit of repeat liver resections for recurrent colorectal metastases: 143 cases. Association Francaise de Chirurgie.

1994 ◽  
Vol 12 (7) ◽  
pp. 1491-1496 ◽  
Author(s):  
B Nordlinger ◽  
J C Vaillant ◽  
M Guiguet ◽  
P Balladur ◽  
F Paris ◽  
...  
Keyword(s):  
Survival Time ◽  
Operative Mortality ◽  
Survival Rates ◽  
Colorectal Metastases ◽  
Term Survival ◽  
Mortality And Morbidity ◽  
Mean Survival Time ◽  
Liver Resections ◽  
The Mean

PURPOSE Resection is the only chance for cure in patients with colorectal liver metastases (LM). Five-year survival rates are close to 25%. Unfortunately, recurrences occur in most patients. Some recurrent LM are technically resectable. The aim of this study was to determine the risks and benefits of repeat resections for recurrent LM. PATIENTS AND METHODS Data from 130 patients who received 143 repeat liver resections for recurrent LM were collected. In 116 patients, only the liver was involved, while 14 had both liver and extrahepatic recurrences. RESULTS In the first group, the operative mortality and morbidity rates were 0.9% and 24.7%, respectively. Two- and 3-year survival rates were 57% and 33%, respectively. Recurrences were observed in 66% of patients. Twelve patients underwent a third hepatectomy for recurrence. The mortality rate was nil, and the mean survival time was 12.5 months. In the group with liver and extrahepatic metastases, the operative mortality and morbidity rates were 0% and 25%. The mean survival time was 16 months. Eleven patients died and 13 had recurrences during the follow-up period. CONCLUSION Some hepatic recurrences after surgical excision of colorectal metastases can be resected with a low operative risk and with a long-term survival rate similar to that obtained after first resections. This emphasizes the need for a careful follow-up after hepatectomy for colorectal metastases to detect resectable recurrences.

scholarly journals AN EARLY EGYPTIAN EXPERIENCEIN OZAKI TECHNIQUE

2020 ◽  
Vol 8 (11) ◽  
pp. 444-448
Author(s):  
Mohamed A. El-badawy ◽  
◽  
Mohamed R. Abdelbaky ◽  
Mostafa M. Abdalraouf ◽  
Hussein A. Zaher ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Postoperative Bleeding ◽  
Mechanical Valve ◽  
Mortality And Morbidity ◽  
Replacement Surgery ◽  
Significant Difference ◽  
The Mean

Background: The advantage of Ozaki technique for aortic valve replacement surgery over the conventional approach is still debated. This study aimed to evaluate early outcomes after aortic valve replacement using the Ozaki technique Methods: We prospectively included 20 patients who had aortic valve replacement May 2018 to June 2020. Postoperative bleeding, mechanical ventilation, ICU stay and echocardiographic outcomes were observed. Results: The mean age was 39.9±14.8 (20-69) years.13 patient had aortic regurge while 7 had aortic stenosis. Aortic cross-clamp (76.2±8.5 (60-100) and cardiopulmonary bypass times (103.8±15.3 (80-125).One patient (5%) was converted to aortic valve replacement by mechanical valve due to significant aortic regurge. Neither significant gradient nor regurge was found on one month follow-up echography. Freedom from infective endocarditis was found in all patients. No significant difference was found in the ejection fraction pre and post-operative. Conclusion: This novel technique seems to have a promising and favorable outcome with no need for anticoagulation and lesser post-operative complication compared to ordinary aortic valve replacement. This technique is associated with low mortality and morbidity.

Minimally Invasive Transaortic Repair of the Mitral Valve

2011 ◽  
Vol 14 (4) ◽  
pp. 232 ◽  
Author(s):  
Orlando Santana ◽  
Joseph Lamelas
Keyword(s):  
Mitral Valve ◽  
Aortic Valve ◽  
Mitral Regurgitation ◽  
Aortic Valve Replacement ◽  
Minimally Invasive ◽  
Valve Replacement ◽  
Operative Mortality ◽  
The Mean ◽  
Transaortic Approach

<p><b>Objective:</b> We retrospectively evaluated the results of an edge-to-edge repair (Alfieri stitch) of the mitral valve performed via a transaortic approach in patients who were undergoing minimally invasive aortic valve replacement.</p><p><b>Methods:</b> From January 2010 to September 2010, 6 patients underwent minimally invasive edge-to-edge repair of the mitral valve via a transaortic approach with concomitant aortic valve replacement. The patients were considered to be candidates for this procedure if they were deemed by the surgeon to be high-risk for a double valve procedure and if on preoperative transesophageal echocardiogram the mitral regurgitation jet originated from the middle portion (A2/P2 segments) of the mitral valve.</p><p><b>Results:</b> There was no operative mortality. Mean cardiopulmonary bypass time was 137 minutes, and mean cross-clamp time was 111 minutes. There was a significant improvement in the mean mitral regurgitation grade, with a mean of 3.8 preoperatively and 0.8 postoperatively. The ejection fraction remained stable, with mean preoperative and postoperative ejection fractions of 43.3% and 47.5%, respectively. Follow-up transthoracic echocardiograms obtained at a mean of 33 days postoperatively (range, 8-108 days) showed no significant worsening of mitral regurgitation.</p><p><b>Conclusion:</b> Transaortic repair of the mitral valve is feasible in patients undergoing minimally invasive aortic valve replacement.</p>

Hybrid Endovascular Repair of Thoracoabdominal Aorta: Early Results

2014 ◽  
Vol 17 (3) ◽  
pp. 146
Author(s):  
Osman Tansel Darcin ◽  
Mehmet Kalender ◽  
Ayse Gul Kunt ◽  
Okay Guven Karaca ◽  
Ata Niyazi Ecevit ◽  
...  
Keyword(s):  
Endovascular Repair ◽  
Therapeutic Option ◽  
Complete Recovery ◽  
Aortic Aneurysms ◽  
Thoracoabdominal Aorta ◽  
Mortality And Morbidity ◽  
Early Results ◽  
The Mean ◽  
Procedural Success

<p><b>Background:</b> Thoracoabdominal aortic aneurysms (TAAA) present a significant clinical challenge, as they are complex and require invasive surgery. In an attempt to prevent considerably high mortality and morbidity in open repair, hybrid endovascular repair has been developed by many authors. In this study, we evaluated the early-term results obtained from this procedure.</p><p><b>Methods:</b> From November 2010 to February 2013, we performed thoracoabdominal hybrid aortic repair in 18 patients. The mean age was 68 years (12 men, 6 women). All of the patients had significant comorbidities. Follow-up computed tomography (CT) scans were performed at 1 week, 3 months, 6 months, and annually thereafter.</p><p><b>Results:</b> All patients were operated on in a staged procedure and stent graft deployment was achieved. Procedural success was achieved in all cases. All patients were discharged with complete recovery. No endoleaks weres detected in further CT examination.</p><p><b>Conclusion:</b> Our results suggests that hybrid debranching and endovascular repair of extensive thoracoabdominal aneurysms represents a suitable therapeutic option to reduce the morbidity and mortality of TAAA repair, particularly in those typically considered at high risk for standard repair.</p>

scholarly journals Surgical treatment of pulmonary artery sarcoma: a report of 17 cases

2021 ◽  
Vol 11 (1) ◽  
pp. 204589402098639
Author(s):  
Wu Song ◽  
Long Deng ◽  
Jiade Zhu ◽  
Shanshan Zheng ◽  
Haiping Wang ◽  
...  
Keyword(s):  
Pulmonary Artery ◽  
Survival Rates ◽  
Tumor Resection ◽  
Long Term Results ◽  
Pulmonary Endarterectomy ◽  
Pulmonary Artery Sarcoma ◽  
The Mean ◽  
Operative Findings

Pulmonary artery sarcoma (PAS) is a rare and devastating disease. The diagnosis is often delayed, and optimal treatment remains unclear. The aim of this study is to report our experience in the surgical management of this disease. Between 2000 and 2018, 17 patients underwent operations for PAS at our center. The medical records were retrospectively reviewed to evaluate the clinical characteristics, operative findings, the postoperative outcomes, and the long-term results. The mean age at operation was 46.0 ± 12.4 years (range, 26–79 years), and eight (47.1%) patients were male. Six patients underwent tumor resection alone, whereas the other 11 patients received pulmonary endarterectomy (PEA). There were two perioperative deaths. Follow-up was completed for all patients with a mean duration of 23.5 ± 17.6 months (1–52 months). For all 17 patients, the median postoperative survival was 36 months, and estimated cumulative survival rates at 1, 2, 3, and 4 years were 60.0%, 51.4%, 42.9%, and 21.4%, respectively. The mean survival was 37.0 months after PEA and 14.6 months after tumor resection only ( p = 0.046). Patients who had no pulmonary hypertension (PH) postoperatively were associated with improved median survival (48 vs. 5 months, p = 0.023). In conclusion, PAS is often mistaken for chronic pulmonary thromboembolism. The prognosis of this very infrequent disease remains poor. Early detection is essential for prompt and best surgical approach, superior to tumor resection alone, and PEA surgery with PH relieved can provide better chance of survival.

scholarly journals AB0549 THE RELEVANCE OF AORTIC STENOSIS AND OUTCOME OF TAVI PROCEDURE FOR VALVE REPAIR IN SCLERODERMA PATIENTS

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1571.3-1571
Author(s):  
A. Balbir-Gurman ◽  
Y. Braun-Moscovici
Keyword(s):  
Aortic Valve ◽  
Valve Replacement ◽  
Pacemaker Implantation ◽  
Significant Coronary Artery Disease ◽  
Heart Catheterization ◽  
Long Term Outcome ◽  
Aortic Valve Implantation ◽  
Valve Pathology ◽  
Valve Implantation

Background:Patients with systemic sclerosis (SSc) are at risk for developing aortic valve changes. The prevalence of aortic valve stenosis (AS) in SSc patients is unknown. Previously, patients with AS were treated with valve replacement; in recent years, Trans Catheter Aortic Valve Implantation (TAVI) is widely used in general population. The safety of Trans Catheter Aortic Valve Implantation (TAVI) in SSc has not been assessed.Objectives:A retrospective study on aortic valve pathology and treatments including TAVI performance.Methods:We reviewed 374 records of SSc patients at our site EUSTAR cohort and extracted cases with reported AS confirmed by ECHO cardiography and heart catheterization.Results:We found data on 13 (3.4%) patients with AS: 12 females (92.3%); mean age 70.3 (SD 7.7) years, disease duration 15.4 (SD 6.3) years. Ten patients had limited SSc (76.9%, all cared anti-centromere antibodies) and 3 diffuse SSc (1 patient had RNAP3 and 2 had anti-topoisomerase antibodies); 5 (38.5%) patients had significant coronary disease (3 underwent CABG, 2 had several PTCA). Eight (61.5%) patients dead during years 2004 - 2019. Aortic valve replacement was performed in 5 patients (4 – metal and 1 – biological); 2 patients did not undergo AS repair due to impaired general condition; 6 patients underwent TAVI between January 2013 and December 2019 (5 at Rambam Cardiology Institute). All SSc patients underwent trans femoral TAVI under conscious sedation. The procedure was successful in all patients. The length of hospitalization was 5-14 days (mean 8.2 days); 3 (50%) patients needed pacemaker implantation (they did not have previous conduction abnormalities). The follow-up duration after TAVI was between 5 and 67 months (mean 20.7). During follow-up one patient developed bacterial endocarditis related to pacemaker device two months after the procedure; the event resolved after removing the device and according antibiotics treatment; the same patient had transient ischemic attack two years later and another pacemaker implantation 3 years later due to complete AV block. One patients dead from urosepsis 11 months after TAVI, the death was not related to procedure. One patient developed anemia due to large hematoma after the procedure.Conclusion:Screening for aortic valve pathology is essential as AS is not rare in SSc patients especially in those with long standing limited disease and positivity to centromere antibodies. AS in SSc patients may be associated with clinically significant coronary artery disease. TAVI was safe in our SSc patients without in-hospital mortality and benign long-term outcome.Disclosure of Interests:Alexandra Balbir-Gurman Consultant of: Novartis, Yolanda Braun-Moscovici: None declared

scholarly journals Partial pulpotomy without age restriction: a retrospective assessment of permanent teeth with carious pulp exposure

2021 ◽  
Author(s):  
Florin Eggmann ◽  
Thomas J. W. Gasser ◽  
Hanjo Hecker ◽  
Mauro Amato ◽  
Roland Weiger ◽  
...  
Keyword(s):  
Survival Rates ◽  
Age Groups ◽  
Permanent Teeth ◽  
Eligibility Criteria ◽  
Presumptive Diagnosis ◽  
Tooth Discoloration ◽  
Significant Difference ◽  
Pulp Exposure ◽  
The Mean

Abstract Objectives This study aimed to retrospectively evaluate clinical and radiographic outcomes of partial pulpotomy performed in permanent teeth with carious pulp exposure. Materials and methods Records of patients undergoing treatment at an undergraduate dental clinic between 2010 and 2019 were screened for partial pulpotomies in teeth with a presumptive diagnosis of normal pulp or reversible pulpitis. The follow-up had to be ≥ 1 year. Patient data were retrieved and analyzed using Mantel-Cox chi square tests and Kaplan–Meier statistics. The level of significance was set at α = 0.05. Results Partial pulpotomy was performed in 111 cases, of which 64 (58%) fulfilled the eligibility criteria. At the time of partial pulpotomy, the mean age was 37.3 (± 13.5) years (age range 18–85). The mean observation period was 3.1 (± 2.0) years. Two early failures (3.1%) and five late failures (7.7%) were recorded. The overall success rate of maintaining pulp vitality was 89.1%, with 98.4% tooth survival. The cumulative pulp survival rates of partial pulpotomy in patients aged < 30 years, between 30 and 40 years, and > 40 years were 100%, 75.5%, and 90.5%, respectively, with no significant difference between the age groups (p = 0.225). At follow-up, narrowing of the pulp canal space and tooth discoloration were observed in 10.9% and 3.1% of cases, respectively. Conclusions Across age groups, partial pulpotomy achieved favorable short and medium-term outcomes in teeth with carious pulp exposure. Clinical relevance Adequate case selection provided, partial pulpotomy is a viable operative approach to treat permanent teeth with deep carious lesions irrespective of patients’ age.

Sign in / Sign up

Export Citation Format

Share Document