scholarly journals CENTRIFUGAL-FLOW LVAD INFLOW CANNULA POSITION: PREOPERATIVE INFLUENCES AND POSTOPERATIVE OUTCOMES

2021 ◽  
Author(s):  
Erik Sorensen ◽  
Bartley Griffith ◽  
Erika Feller ◽  
Lynn Dees ◽  
David Kaczorowski
Keyword(s):  
Axial Flow ◽  
Flow Index ◽  
Angular Deviation ◽  
Pump Thrombosis ◽  
Lateral Plane ◽  
Ideal Line ◽  
Inflow Cannula ◽  
Implant Technique ◽  
Lateral Thoracotomy

Background: We previously demonstrated better inflow cannula (IFC) position and reduced pump thrombosis with a centrifugal-flow LVAD (CF-LVAD) compared to an axial-flow device. We hypothesized that implant technique and patient anatomy would affect CF-LVAD IFC positioning and that malposition would impact LV unloading and outcomes. Methods: Pre- and postoperative computed tomography (CT) scans were reviewed for patients with six-month follow-up. Malposition was quantified using angular deviation from an ideal line in two planes. IFC position was compared between conventional sternotomy (CS) and lateral thoracotomy-hemisternotomy (LTHS). The influence of LV end-diastolic dimension (LVEDD), body mass index (BMI), and CT-derived anatomy was determined. LV unloading was assessed by LVAD flow index (FI) and pre- to post-LVAD decrement in mitral regurgitation (MR) and LVEDD. Outcome measures were pump thrombus or stroke (PT/eCVA); 30-day and total heart failure-related readmissions (HFRAs); and survival free of surgery for LVAD dysfunction. Results: One hundred fourteen patients met criteria. Total malposition magnitude was higher for CS than LTHS (p=0.04). Midline-LV apex distance predicted lateral-plane malposition (p=0.04), while apex-LVOT angle predicted both anterior- (p=0.01) and lateral-plane (p=0.04) malposition. Lateral-plane malposition predicted decreased LVAD FI at three (p=0.03) and six (p=0.01) months. Total malposition magnitude predicted increased 30-day HFRAs (p=0.04), while lateral-plane malposition predicted more overall HFRAs (p=0.01). Malposition was not associated with PT/eCVA, changes in MR or LVEDD, or survival free of surgical revision. Conclusions: Patient anatomy and surgical technique were associated with CF-LVAD IFC malposition. In turn, malposition was associated with increased readmissions and decreased LVAD FI.

scholarly journals Low Incidence of Gastrointestinal Bleeding and Pump Thrombosis in Patients Receiving the INCOR LVAD System in the Long-term Follow-up

2015 ◽  
Vol 38 (10) ◽  
pp. 542-547 ◽  
Author(s):  
Attilio Iacovoni ◽  
Paolo Centofanti ◽  
Matteo Attisani ◽  
Alessandro Verde ◽  
Amedeo Terzi ◽  
...  
Keyword(s):  
Gastrointestinal Bleeding ◽  
Pump Thrombosis ◽  
Long Term Follow Up ◽  
Low Incidence

scholarly journals Paraganglioma in the posterior mediastinum: a case report

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Jong-Ho Nam ◽  
Jong-Seon Park ◽  
Joon Hyuk Choi
Keyword(s):  
Posterior Mediastinum ◽  
Tracer Uptake ◽  
Case Presentation ◽  
Long Term Follow Up ◽  
Adrenergic Blockers ◽  
Adrenal Chromaffin ◽  
Paravertebral Mass ◽  
Lateral Thoracotomy

Abstract Background Paragangliomas are tumors that arise from extra-adrenal chromaffin cells. Herein, we present a rare case of a functional paraganglioma in the posterior mediastinum. Case presentation A 36-year-old man presented with paroxysms of chest pain and headache. At presentation, the patient’s blood pressure was 190/120 mmHg. Chest computed tomography and magnetic resonance imaging revealed a left paravertebral mass in the posterior mediastinum. 123I-metaiodobenzylguanidine scanning revealed focally high tracer uptake in the left paravertebral area. The metanephrine level in the urine was elevated, confirming a rare, catecholamine-producing, functional paraganglioma in the posterior mediastinum. Before surgery, the patient was prepared by orally administering α- and β-adrenergic blockers. The mass was then resected via a lateral thoracotomy. The metanephrine level in urine was normal 24 h after surgery. Conclusions Paragangliomas in the posterior mediastinum are very rare, but more than half of all cases are functional. The associated symptoms are curable with complete resection, and long-term follow-up for recurrence is important.

scholarly journals Computer-designed selective laser sintering surgical guide and immediate loading dental implants with definitive prosthesis in edentulous patient: A preliminary method

2014 ◽  
Vol 08 (01) ◽  
pp. 100-106 ◽  
Author(s):  
Giovanni Di Giacomo ◽  
Jorge Silva ◽  
Rodrigo Martines ◽  
Sergio Ajzen
Keyword(s):  
Dental Implants ◽  
Computer Aided Design ◽  
Manufacturing Systems ◽  
Surgical Planning ◽  
Selective Laser Sintering ◽  
Laser Sintering ◽  
Angular Deviation ◽  
Surgical Guide ◽  
Computer Aided

ABSTRACT Objective: The aim of this study was to analyze a preliminary method of immediately loading dental implants and a definitive prosthesis based on the computer-aided design/computer-aided manufacturing systems, after 2 years of clinical follow-up. Materials and Methods: The study comprised one patient in good general health with edentulous maxilla. Cone beam computer tomography (CBCT) was performed using a radiographic template. The surgical plan was made using the digital imaging and communications in medicine protocol with ImplantViewer (version 1.9, Anne Solutions, Sao Paulo, SP, Brazil), the surgical planning software. These data were used to produce a selective laser sintering surgical template. A maxilla prototype was used to guide the prosthesis technician in producing the prosthesis. Eight dental implants and a definitive prosthesis were installed on the same day. A post-operative CBCT image was fused with the image of the surgical planning to calculate the deviation between the planned and the placed implants positions. Patient was followed for 2 years. Results: On average, the match between the planned and placed angular deviation was within 6.0 ± 3.4° and the difference in coronal deviation was 0.7 ± 0.3 mm. At the end of the follow-up, neither the implant nor the prosthesis was lost. Conclusions: Considering the limited samples number, it was possible to install the dental implants and a definitive prosthesis on the same day with success.

scholarly journals Ilizarov technique combined with limited adjunctive surgical procedures for correction of relapsed talipes equinovarus in children

2017 ◽  
Vol 46 (2) ◽  
pp. 802-810 ◽  
Author(s):  
Xiao-Jian Wang ◽  
Feng Chang ◽  
Yun-Xing Su ◽  
Xiao-Chun Wei ◽  
Lei Wei
Keyword(s):  
Study Group ◽  
Ilizarov Technique ◽  
Efficacy And Safety ◽  
Limited Surgery ◽  
Talipes Equinovarus ◽  
Before And After ◽  
Lateral Plane ◽  
The Mean ◽  
Surgical Operations

Objective To evaluate the efficacy and safety of using the Ilizarov invasive distraction technique combined with limited surgical operations in the treatment of relapsed talipes equinovarus in children. Methods This retrospective study analysed the outcomes of paediatric patients with relapsed talipes equinovarus who were treated with the Ilizarov technique with moderate open limited soft tissue or bony operations. The International Clubfoot Study Group (ICFSG) classification system score was used to evaluate the deformities before and after surgery. Results The study evaluated 16 feet in 14 patients (nine boys). The correction time ranged from 6 to 12 weeks. The mean duration of frame application was 5.9 months. The gait was improved significantly in all patients. At final follow-up, the mean ankle dorsiflexion and plantarflexion ranges were 8.3° and 34.6°, respectively. The talocalcaneal angle improved from 10.0° preoperatively to 28.3° postoperatively in the anteroposterior plane; and from 4.1° preoperatively to 42.1° postoperatively in the lateral plane. The differences in the angle of plantarflexion, dorsiflexion, range of motion of the ankle joint and talocalcaneal angles pre- and postoperation were significant. Conclusions These current findings suggest that the Ilizarov technique combined with limited surgery effectively corrects relapsed talipes equinovarus in children.

Non-pulsatile circulation with axial-flow left ventricular assist device preserves neurocognitive function

Perfusion ◽  
2010 ◽  
Vol 25 (4) ◽  
pp. 225-228 ◽  
Author(s):  
Helena Argiriadou ◽  
Kalliopi Megari ◽  
Polychronis Antonitsis ◽  
Mary H. Kosmidis ◽  
Christos Papakonstantinou ◽  
...  
Keyword(s):  
Axial Flow ◽  
Circulation Pattern ◽  
Neurocognitive Function ◽  
Left Ventricular ◽  
Ventricular Assist Devices ◽  
Left Ventricular Assist Devices ◽  
Ventricular Assist ◽  
Left Ventricular Assist ◽  
New Generation

Concerns about the potential impact of the non-pulsatile circulation pattern generated by the new generation axial-flow left ventricular assist devices on neurocognitive function led us to evaluate a patient in whom a Jarvik 2000 pump was implanted. We assessed the patient’s baseline neurocognitive function preoperatively as well as at 1-month and 6-month follow-up, using a comprehensive battery of neuropsychological tests. A slight improvement in circumscribed neurocognitive domains was noted, with no evidence of further decline at the end of a 6-month follow-up period.

scholarly journals The accuracy and safety of CT-guided iodine-125 seeds implantation assisted by 3D non-coplanar template for retroperitoneal recurrent carcinoma.

2020 ◽  
Author(s):  
Weijuan Jiang ◽  
Ping Jiang ◽  
Shuhua Wei ◽  
Yuliang Jiang ◽  
Zhe Ji ◽  
...  
Keyword(s):  
Real Time ◽  
Planning System ◽  
Treatment Planning System ◽  
Angular Deviation ◽  
Ct Guided ◽  
The Mean ◽  
Iodine 125 ◽  
Preoperative Plan ◽  
Time Plan

Abstract Purpose To investigate the accuracy, dosimetric parameters and safety of 3D-printing non co-planar template (3D-PNCT) assisted CT-guidance for radioactive iodine-125 (125I) seed implantation brachytherapy (RSI-BT) for retroperitoneal recurrent carcinomas. Methods and materials: We enrolled 15 patients with 17 retroperitoneal recurrent carcinomas after external beam radiotherapy (EBRT). All patients received CT-guided 125I RSI-BT assisted by 3D-PNCT successfully. We compared the original needles insertion position, angular and the needle tips distance deviations of preoperative plan with that of intra-operative in brachytherapy treatment-planning system (B-TPS). The dosimetric parameters of RSI-BT were evaluated on preoperative plan, intra-operative real-time plan and postoperative plan, including D90, D100, V100, V150 and V200. The quality assurance of RSI-BT evaluated on conformal index (CI), external index (EI), homogeneity index (HI) of the targets were compared among preoperative plan, intra-operative real-time plan and postoperative plan. The peri-operation complications and re-radiation related toxicity were assessed. Results The median follow-up was 8.2 months (range 1-18.5months). One patient lost follow-up after RSI-BT. 14 patients were assessed for response rate and toxicity. The mean entrance point distance deviation for all 165 needles was 4.50 ± 4.10 mm (range, 0–30). The mean angular deviation was 2.70 ± 3.00 degrees (range, 0–20). The needles tip distances deviation was 6.90 ± 6.00 mm (range, -30-28). D90 for preoperative plan, intra-operative plan and postoperative plan were 140.55 ± 23.93, 124.25 ± 28.04,128.98 ± 22.75. There was significant difference between D90 of preoperative plan with that of intraoperative plan (p = 0.036). Four patients reached CR, three patients reached PR, three patients were SD and three patients was PD. Four patients with middle pain became moderate, two with moderate pain relived completely after RSI-BT. The others parameters showed no differences among preoperative plan, intraoperative plan and postoperative plan. The perioperative complications were observed in four patients, including three patients of grade 1 and one patient of grade 2. No ≥ grade 3 side-effects were observed. Conclusion CT-guided 125I RSI-BT assisted by 3D-PNCT was a safe, accurate and feasible strategy for recurrent carcinomas located in retroperitoneal regions.

scholarly journals Numerical analysis of the effect of the design of axial-flow pump cannula tip on stagnation and recirculation zones in the left ventricle

2020 ◽  
Vol 22 (2) ◽  
pp. 107-112
Author(s):  
M. S. Nosov ◽  
G. P. Itkin ◽  
V. M. Zaiko ◽  
V. A. Malgichev
Keyword(s):  
Left Ventricle ◽  
Axial Flow ◽  
Left Ventricular ◽  
Ventricular Assist ◽  
Axial Flow Blood Pump ◽  
Left Ventricular Assist ◽  
Inflow Cannula ◽  
Recirculation Zones ◽  
Axial Flow Pump

Objective: to analyze the inflow cannula of an implantable axial-flow blood pump for a long-term left ventricular assist system in order to minimize thromboembolic complications. Materials and methods. Hemodynamics was considered for 4 different designs of the inflow cannula, from 0 mm to 25 mm long. Areas at the base of the cannula received the most attention. Analysis was performed using the OpenFOAM software. Results. It was revealed that sizes of stagnation and recirculation zones directly depended on the length of the cannula when placed in the left ventricle. Accordingly, longer cannula increases the risk of thrombosis. Conclusion. The design of an inflow cannula determines the likelihood of thrombosis in the cannula. Longer inflow cannula increases stagnation and recirculation zones. This provides a basis for a search for other possible modifications.

scholarly journals Comparative efficacy of autologous versus cadaveric saphenous vein grafts in cerebral revascularization surgery

2020 ◽  
pp. 1-7 ◽  
Author(s):  
Christopher J. Stapleton ◽  
Ahmed E. Hussein ◽  
Mandana Behbahani ◽  
Ali Alaraj ◽  
Sepideh Amin-Hanjani ◽  
...  
Keyword(s):  
Blood Flow ◽  
Saphenous Vein ◽  
Statistical Significance ◽  
Cerebral Revascularization ◽  
Flow Index ◽  
Vein Grafts ◽  
Saphenous Vein Grafts ◽  
Bypass Patency ◽  
Revascularization Surgery

OBJECTIVECerebral bypasses are performed for the purpose of either flow augmentation for ischemic cerebrovascular disease or flow replacement for vessel sacrifice during complex aneurysm or tumor surgery. Saphenous vein grafts (SVGs) are commonly used interposition grafts. The authors of this study sought to compare the efficacy of autologous versus cadaveric SVGs in a large series of cerebral bypasses using interposition vein grafts with long-term angiographic follow-up.METHODSAll intracranial bypass procedures performed between 2001 and 2018 were reviewed. Demographic, clinical, angiographic, and operative data were recorded and then analyzed according to SVG type.RESULTSA total of 308 consecutive intracranial bypasses were performed during the study period, 53 (17.2%) of which were bypasses with an interposition SVG (38 autologous, 15 cadaveric). At a median follow-up of 2.2 months (IQR 0.2–29.1), 39 (73.6%) bypasses were patent (26 [68.4%] autologous, 13 [86.7%] cadaveric, p = 0.30). Comparing autologous and cadaveric SVG recipients, there were no statistically significant differences in age (p = 0.50), sex (p > 0.99), history of smoking (p = 0.75), hypertension (p > 0.99), diabetes mellitus (p = 0.13), indication for bypass (p = 0.27), or SVG diameter (p = 0.65). While there were higher intraoperative (autologous, 100.0 ml/min, IQR 84.3–147.5; cadaveric, 80.0 ml/min, IQR 47.3–107.8; p = 0.11) and postoperative (autologous, 142.2 ml/min, IQR 76.8–160.8; cadaveric, 92.0 ml/min, IQR 69.2–132.2; p = 0.42) volumetric flow rates in the autologous SVGs compared to those in the cadaveric SVGs, the difference between the two groups did not reach statistical significance. In addition, the blood flow index, or ratio of postoperative to intraoperative blood flow, for each bypass was similar between the groups (autologous, 1.3, IQR 0.9–1.6; cadaveric, 1.5, IQR 1.0–2.3; p = 0.37). Kaplan-Meier estimates showed no difference in bypass patency rates over time between autologous and cadaveric SVGs (p = 0.58).CONCLUSIONSCadaveric SVGs are a reasonable interposition graft option in cerebral revascularization surgery when autologous grafts are not available.

P1675Evolution of lactate dehydrogenase levels in patients with HeartMate II, HeartWare and HeartMate 3 left ventricular assist devices during first-year follow-up

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
Y C Yalcin ◽  
R Muslem ◽  
G Papageorgiou ◽  
R J Tedford ◽  
A A Constantinescu ◽  
...  
Keyword(s):  
Lactate Dehydrogenase ◽  
Left Ventricular ◽  
Ventricular Assist Devices ◽  
First Year ◽  
Heartmate Ii ◽  
Ventricular Assist ◽  
Pump Thrombosis ◽  
Left Ventricular Assist ◽  
Over Time

Abstract Background Lactate dehydrogenase (LDH) is considered as a biomarker of thrombotic events in patients receiving a left ventricular assist device (LVAD). Purpose This study aimed to investigate the evolution of LDH levels over time between patients supported with a HeartMate II (HMII), HeartMate 3 (HM3) or HeartWare (HVAD) LVAD during their first-year post implantation. Methods We analyzed in this multi-center retrospective study, all patients with HMII, HM3 and HVAD LVAD implanted between December 2006 and April 2017. Patients were classified into three groups based on their device type. Loess splines over time were used to depict the repeated measurements of LDH. Results In total, 134 patients received an LVAD (77% male, mean age 55 [46–61]), of whom 64 (48%) were HMII, 22 (16%) HM3 and 48 (36%) were HVAD. Loess splines over time indicate that there could be a considerable difference between evolution of LDH (Figure). During the first-year follow-up, 3 (5%) patients had a confirmed and 10 (16%) patients had a suspected pump thrombosis in the HMII group. For the HVAD, there were 6 (13%) patients with confirmed thrombosis and 1 (2%) case of suspected thrombosis, whereas none of the patients in the HM3 group experienced a suspected or confirmed pump thrombosis (p=0.01). The 1-year overall survival rate for HM II, HM3 and HVAD was 84%, 86% and 72% respectively (p=0.311). The overall stroke-free rate at one year was: 89%, 77% and 91% for HMII, HVAD and HM3 respectively (p=0.15). Means of observed LDH values over time Conclusion During the first-year post LVAD implantation, there appear to be different evolutions of LDH levels over time in HMII device patients compared to HVAD or HM3 device patients. Given differences in baseline hemolysis levels between devices, currently used LDH thresholds for detection of impending pump thrombosis may be less sensitive and thus thresholds may be device specific.

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