scholarly journals Echocardiographic and Computed-tomographic Evaluation of the Fate of Bovine Pericardial Patch as a Pericardial Substitute in Bentall’s Procedure: Twenty-year’ Results

2022 ◽  
Vol 5 (1) ◽  
pp. 01-12
Author(s):  
Ujjwal K. Chowdhury ◽  
Shikha Goja ◽  
Lakshmi Kumari Sankhyan ◽  
Niraj Nirmal Pandey ◽  
Sudheer Arava ◽  
...  
Keyword(s):  
Graft Infection ◽  
Pericardial Patch ◽  
Actuarial Survival ◽  
Mattress Suture ◽  
Annuloaortic Ectasia ◽  
Jude Medical ◽  
Pericardial Cavity ◽  
Bovine Pericardial Patch ◽  
Mediastinal Infection

Objective: The study was designed to ascertain the influence of usage of bovine pericardial patch in patients undergoing Bentall’s procedure with respect to reexploration for bleeding, mediastinal infection, avoidance of conduit adhesions, late development of pericardial constriction and calcification. Materials and Methods: We reviewed 150 patients (79 males) aged between 22 to 68 years (mean±SD 49.25±12.9 years) receiving a composite aortic conduit between January 1998 to December 2020 for annuloaortic ectasia (n=100), aortic dissection (n=49), and dilated aortic root in repaired tetralogy of Fallot (n=1). Twenty-five patients had Marfan’s syndrome. Modified “button technique” was performed by interposing a glutaraldehyde treated pericardial strip at the graft coronary anastomoses, and proximal aortic conduit suturing using interlocking interrupted, pledgeted mattress suture. On completion, the pericardial cavity was reconstructed using St. Jude Medical Biocor pericardial patch. To detect evidence of pericardial constriction, survivors underwent echocardiography and computed tomography. The Kaplan-Meier curve was drawn to show the probability of survival over a period of follow-up time. Results: Seven (4.7%) patients died of cardiac-related cause, 45% had transient hemodynamic instability, 55% had low cardiac output, and 87.1% had spontaneous return of sinus rhythm. The average 12-hour postoperative drainage was 245±70 ml and there was no mediastinal infection. At a mean follow-up of 172.4 (SD± 58.9) months, the actuarial survival was 94.2±0.04% (95% CI: 88.5-96.8), and there was no pericardial constriction or calcification. Conclusion: Reconstruction of pericardial cavity using Biocor bovine pericardial patch minimizes diffuse oozing of blood, graft infection, and is not associated with later development of pericardial constriction, or calcification.

scholarly journals Long-Term Follow-Up of Pericardium for the Ventricular Component in Atrioventricular Septal Defect Repair

2020 ◽  
Vol 11 (6) ◽  
pp. 742-747
Author(s):  
Rinske J. IJsselhof ◽  
Saniyé D. R. Duchateau ◽  
Rianne M. Schouten ◽  
Martijn G. Slieker ◽  
Mark G. Hazekamp ◽  
...  
Keyword(s):  
Septal Defect ◽  
Atrioventricular Septal Defect ◽  
Pericardial Patch ◽  
Atrioventricular Valve ◽  
Autologous Pericardium ◽  
Bovine Pericardial Patch ◽  
Significant Difference ◽  
Long Term Follow Up ◽  
Defect Repair

Background: Despite the improved outcome in complete atrioventricular septal defect (AVSD) repair, reoperations for left atrioventricular valve (LAVV) dysfunction are common. The aim of this study was to evaluate the effect of fresh untreated autologous pericardium for ventricular septal defect (VSD) closure on atrioventricular valve function and compare the results with the use of treated bovine pericardial patch material. Methods: Clinical and echocardiographic data were collected of patients with complete AVSD with their VSD closed with either untreated autologous pericardial or treated bovine pericardial patch material between January 1, 1996, and December 31, 2003. Evaluation closed in September 2019. Results: A total of 77 patients were analyzed (untreated autologous pericardial VSD patch: 59 [77%], treated bovine pericardial VSD patch: 18 [23%]). Median age at surgery was 3.6 (interquartile range [IQR]: 2.7-4.5) months, and median weight was 4.5 (IQR: 3.9-5.1) kg. Trisomy 21 was present in 70 (91%) patients. Median follow-up time was 17.5 (IQR: 12.6-19.8) years. Death <30 days occurred in two (3%) patients. Reinterventions occurred in eight patients (early [within 30 days] in two, early and late in one, and late in five), all in the autologous pericardium group. Log-rank tests showed no significant difference in mortality ( P = .892), LAVV reinterventions ( P = .228), or LAVV regurgitation ( P = .770). Conclusions: In AVSD, the VSD can safely be closed with either untreated autologous pericardium or xeno-pericardium. We found no difference in LAVV regurgitation or the need for reoperation between the two patches.

scholarly journals Surgical Treatment of Annuloaortic Ectasia – Replace or Repair?

Aorta ◽  
2017 ◽  
Vol 05 (05) ◽  
pp. 139-147 ◽  
Author(s):  
Andrea De Martino ◽  
Federico Re ◽  
Stefania Blasi ◽  
Michele Celiento ◽  
Giacomo Ravenni ◽  
...  
Keyword(s):  
Late Results ◽  
Functional Class ◽  
Long Term Results ◽  
Actuarial Survival ◽  
Annuloaortic Ectasia ◽  
Severe Aortic Regurgitation ◽  
Bentall Procedure ◽  
Group 2 ◽  
Group 1

Background: Patients with annuloaortic ectasia may be surgically treated with modified Bentall or David I valve-sparing procedures. Here, we compared the long-term results of these procedures. Methods: A total of 181 patients with annuloaortic ectasia underwent modified Bentall (102 patients, Group 1) or David I (79 patients, Group 2) procedures from 1994 to 2015. Mean age was 62 ± 11 years in Group 1 and 64 ± 16 years in Group 2. Group 1 patients were in poorer health, with a lower ejection fraction and higher functional class. Results: Early mortality was 3% in Group 1 and 2.5% in Group 2. Patients undergoing a modified Bentall procedure had a higher incidence of thromboembolism and hemorrhage, whereas those undergoing a David I procedure had a higher incidence of endocarditis. Actuarial survival was 70 ± 6% at 15 years in Group 1 and 84 ± 7% at 10 years in Group 2. Actuarial freedom from reoperation was 97 ± 2% at 15 years in Group 1 and 84 ± 7% at 10 years in Group 2. In Group 2, freedom from procedure-related reoperations was 98 ± 2% at 10 years. At last follow-up, no cases of moderate or severe aortic regurgitation were observed. Conclusions: The modified Bentall and David I procedures showed excellent early and late results. The modified Bentall procedure with a mechanical conduit was associated with thromboembolic and hemorrhagic complications, whereas the David I procedure was associated with unexplained occurrences of endocarditis. Thus, the David I procedure appears to be safe, reproducible, and capable of achieving stable aortic valve repair and is therefore our currently preferred solution for patients with annuloaortic ectasia. However, the much shorter follow-up for David I patients limits the strength of our comparison between the two techniques.

Templates of flat pericardial patterns for precise aortic cusp extension

2018 ◽  
Vol 26 (5) ◽  
pp. 361-366 ◽  
Author(s):  
Mohammad Bashar Izzat ◽  
Mohammad Mouath Alkhayat
Keyword(s):  
Aortic Valve ◽  
Aortic Insufficiency ◽  
Pericardial Patch ◽  
Aortic Valve Insufficiency ◽  
Aortic Cusp ◽  
Bovine Pericardial Patch ◽  
Natural Geometry ◽  
Intraoperative Transesophageal Echocardiography ◽  
Valve Insufficiency

Background Aortic cusp extension is a subjective and operator-dependent technique. In order to facilitate surgical correction of aortic cusp retraction and reestablishment of adequate cusp coaptation, we sought to develop new templates that can be used to cut flat pericardial sheets into precise cusp extension patches. Methods Each template was designed as a two-dimensional unwrap of the natural geometry of a complete aortic cusp, and a series of templates were made available to correspond with all potential aortic cusp sizes. Based on these templates, aortic cusp extension was performed in 2 patients (aged 54 and 43 years) with significant retraction of the noncoronary aortic cusps and severe aortic valve insufficiency. In each patient, extension of the retracted native noncoronary cusp was undertaken using a bovine pericardial patch that matched the size of adjacent nondiseased native aortic cusps. Results Achieving geometrically perfect aortic cusp extensions was uncomplicated, and intraoperative transesophageal echocardiography confirmed satisfactory aortic valve repairs (aortic insufficiency < 1+ and low transvalvular gradients). Early follow-up transthoracic echocardiography confirmed that all valve cusps met at similar heights in the aortic root, and that their excursions were virtually identical. Conclusions The newly designed templates can be used to cut flat pericardial sheets into exact cusp extension patches, and initial clinical experience indicates that they are useful in performing precise aortic cusp extension procedures and restoring adequate aortic valve competence.

Ovine Biosynthetic Grafts for Aortoiliac Reconstructions in Nonsterile Operative Fields

2021 ◽  
Author(s):  
Hazem El Beyrouti ◽  
Mohammad Bashar Izzat ◽  
Angela Kornberger ◽  
Nancy Halloum ◽  
Kathrin Dohle ◽  
...  
Keyword(s):  
Treatment Group ◽  
Vascular Grafts ◽  
Graft Infection ◽  
Prosthetic Graft ◽  
Vascular Graft Infection ◽  
Vascular Prostheses ◽  
Graft Thrombosis ◽  
Life Threatening ◽  
Omniflow Ii

Abstract Background Prosthetic vascular grafts placed surgically or via endovascular techniques can be subject to the risk of life-threatening graft infections. The Omniflow II vascular prosthesis is a biosynthetic graft that was reported to have favorable properties in resisting infections. Materials and Methods We retrospectively reviewed our 3 years' experience of using the Omniflow II prostheses for aortoiliac reconstructions in patients considered to carry a substantial risk of subsequent prosthetic graft infections (prevention group) as well as in patients with actively infected prosthetic vascular grafts (treatment group). Results Aorto-bi-iliac (n = 4) and aortobifemoral (n = 12) vascular reconstructions were performed using bifurcated Omniflow II prostheses in nine patients in the prevention group and seven patients in the treatment group. During mean follow-up of 28.6 ± 17.2 months, there was one case of graft infection (6.3%) and graft thrombosis (6.3%) with subsequent successful thrombectomy. Early and late surgical revisions were required in eight (50%) and two (12.6%) patients, respectively. All graft prostheses were patent at last follow-up. Conclusion Using bifurcated Omniflow II vascular prostheses in patients with or at a high risk of vascular graft infection is advisable, and is associated with acceptable reinfection and patency rates.

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