Outcomes of the Valve-Sparing Root Replacement Procedure with Partial Upper Sternotomy

Due to better postoperative convalescence and quality of life, experienced centers focus on minimally invasive surgical techniques and approaches, but this approach is not routinely performed for valve-sparing root replacement procedures. The purpose of this study was to assess the safety and feasibility of valve-sparing root replacement via partial upper sternotomy. Between January 2016 and April 2021, 269 patients underwent a valve-sparing root replacement procedure, and partial upper sternotomy was performed in 52 patients. The clinical outcomes of the partial upper sternotomy (PUS) and complete sternotomy (CS) groups, including mortality, degree of aortic insufficiency, blood loss and consumption of blood products, postoperative complications, and hospitalization expenses, were compared. The Kaplan–Meier method was used to assess the degree of aortic regurgitation. Propensity score matching was performed as a sensitivity analysis. There was only one in-hospital death (in the CS group, p = 1) and no postoperative moderate to severe aortic insufficiency in either group. The blood loss and consumption of blood products in the PUS group were also lower than in the CS group, especially for plasma use. Regarding the need for re-exploration because of bleeding, acute kidney injury, pericardial pleural effusion, drainage volume within the first 24 h, mechanical ventilation time, and arrhythmia, the two groups were comparable. Patients in the CS group showed a longer ICU time (74.20 ± 47.21 vs. 50.9 30.16 h, p = 0.001) and higher hospitalization expenses (135,649.52 ± 29,992.21 vs. 123,380.15 ± 27,062.82 yuan, p < 0.001). None of the patients died or reoperated during the follow-up. Freedom from moderate or severe aortic insufficiency remained comparable after matching (p = 0.97). Minimally invasive valve-sparing aortic replacement via partial upper sternotomy can be safely performed in selected patients.

An Evaluation of the Microstructure of High-Aluminum Cast Iron in Terms of the Replacement of Aluminum Carbide with Titanium Carbide or Tungsten Carbide

One of the problems with recycling is that of widespread contaminated steel scrap with an unwanted aluminum addition. In this paper, we will present a specific solution to this problem. The implementation of high-aluminum cast iron production has been considered. This cast iron is a cheap material resistant to high temperatures; additionally, it has increased abrasion resistance. Despite the above-mentioned advantages, high-aluminum cast iron has not been widely used in the industry so far, due to the difficulties encountered during machining and the occurrence of the phenomenon of spontaneous disintegration. The paper presents a method for replacing aluminum carbide with titanium carbide or tungsten carbide. This research shows that the carbide replacement procedure is sufficient in stopping the phenomenon of self-disintegration of a casting made of high-aluminum cast iron. Moreover, a new material was obtained, i.e., high-aluminum cast iron with precipitates of hard tungsten carbide and flake graphite. When considering the abrasive resistance of this material, flake graphite can be treated as the natural lubricant phase and tungsten carbide precipitation, as the hardening phase.

Femoral Stem Fracture and Successful Reimplantation Using Femoral Window Technique in Canine Cemented Total Hip Replacement: Case Report

A fractured stem is a very rare, late complication in total hip replacement procedure in dogs. Here, we present one case after cemented total hip replacement with successful reimplantation, including clinical signs and radiographic findings.

Sutureless aortic valve replacement: a meta-analysis

Background and objectives Sutureless aortic valves aim to achieve better outcomes and to aid and facilitate the minimally invasive aortic valve replacement procedure by tackling the issue of cross clamp time, which is an independent predictor of post-operative outcomes especially in patients with serious comorbidities. (2, 3) By reducing the number of sutures, the time for sutures placement is reduced. (1) Our Meta-analysis tries to assess the safety and hemodynamic performance of the sutureless aortic valve prosthesis’s in an attempt to ascertain their benefits as a viable alternative to current established measures. Methodology From their beginnings to February 2017, electronic searches were conducted using six databases. Relevant studies using commercially accessible suture-free valves to replace the aortic valve have been recognized. Based on the predefined endpoints, data were collected and analyzed. Results FC For incorporation in qualitative and quantitative analyses, twenty-four studies were recognized, with a total number of 5073 patients undergoing sutureless aortic valve replacement (SU-AVR). Mortality incidence at 30 days and 12 months follow-ups were 2.5% and 2.7%, respectively, while the incidence of thromboembolic events (1.6%) and paravalvular leak (PVL) (0.5%) were acceptable. Conclusion Current available evidence indicates that sutureless aortic valve replacement is a safe operation showing low mortality and complication rates, with satisfactory hemodynamic performance.

Transcatheter Aortic Valve Implantation in Younger Patients: A New Challenge

The number of aortic stenosis patients in Western countries is increasing, along with better life conditions and expectancies. Presently, the volume of percutaneous transcatheter aortic valve implantations (TAVIs) is incessantly increasing, and has already overcome the surgical replacement procedure volume. According to the literature, TAVI is a feasible procedure even among low surgical risk patients, and American guidelines have extended the indications for TAVI, including shifting patient evaluations from high/low STS scores to old/young patients, a “paradigm shift” of aortic stenosis evaluation. As a result, low-risk young (<75 years-old) population management could be the next challenge in cardiology. To manage the life conditions of a 65 year old patient affected by aortic stenosis who is undergoing TAVI, one of the most crucial issue will be bioprosthesis durability and the appropriate intervention to make in cases of valve dysfunction or failure.

Clinical analysis of redo aortic root replacement after cardiac surgery: a retrospective study

Objectives To explore the etiology, previous cardiac procedure methods and outcomes of redo aortic root replacement after cardiac surgery. Methods A retrospective analysis of 41 patients who underwent aortic root replacement surgery in our hospital from February 2010 to February 2020 who underwent at least one cardiac surgery in the past, including 27 males and 14 females, with an average age of 49.5 ± 10.2 years old. Indications for reoperation include: aortic sinus dilation and ascending aortic aneurysm in 20 cases (48.8%), recurrent aortic dissection in 7 cases (17.1%), pseudoaneurysm of aortic root in 4 cases (9.8%), prosthetic valve endocarditis in 5 cases (12.2%) and paravalvular leakage in 5 cases (12.2%). According to whether the previous procedure involved aortic root surgery, they were divided into 2 groups, namely aortic root surgery-involved (ARS) group and non-aortic root surgery-involved (NRS) group. After the patients were discharged from hospitals, follow-ups were carried out through outpatient clinic or telephone for 5 years. Kaplan-Meier was used for survival analysis. Results All patients underwent Bentall procedure with a median sternum incision. Six patients (14.6%) died during the postoperative hospitalization and 3 patients (8.6%) died during the follow-up. The 1-year, 3-year, and 5-year survival in ARS group were 92.6, 92.6, and 92.6%, respectively; the 1-year, 3-year, and 5-year survival in NRS group were 100, 85.7, and 85.7%, respectively. There was no statistical difference between the two groups in the cause of redo aortic root replacement, procedure time, postoperative complications, postoperative hospital stay, hospital mortality, and 5-year cumulative survival (p > 0.05). Conclusions Redo aortic root replacement is difficult and high risk. Bentall procedure is still a reliable surgical option for redo aortic root replacement, with good short- and mid-term results. The prognosis of redo aortic root replacement is not necessarily related to the etiology of patient’s surgery and the methods of previous cardiac procedure.

A 6-Month-Old Neglected Obturator Inferior Variety of Anterior Hip Dislocation in A Young Male Managed with an Intermediary Salvage Measure Without the Need for Osteotomy or Excision Arthroplasty with A Resultant Ambulatory Natural Hip – A Case Report

Introduction: Among all the traumatic hip dislocations, anterior hip dislocation is a rarity in which the obturator inferior variety is one of the rarest to be documented [1]. Here we present to you the case of our patient, a 35-year-old male with a six month neglected obturator variety of anterior hip dislocation treated by salvage procedure of open reduction without the need for intertrochanteric osteotomy and resultant preserved natural hip for ambulation as an intermediary procedure. Case Report: Mr. SH a 35-year-old male had a fall from 15 feet in his village and was treated by a local quack, Meanwhile the patient continued to experience pain and difficulty walking and after an ordeal of nearly 6 months during the lockdown period in coronavirus disease pandemic, showed up in our emergency room and was diagnosed with an obturator type anterior hip dislocation for which we carried out open reduction aided with Murphys skid through an anterolateral approach and stabilization using two Steinman pins and further immobilization by Thomas splint for a period of 15 days, which was done after confirmation of intact head vascularity under general anesthesia after which gradual mobilization was initiated. 3 months post operative, now patient is ambulatory with stick support with no deformity, no pain and with early radiological features of avascular necrosis (AVN) for which Total Hip Replacement (THR) is planned at a later date. Conclusion: Utilisation of salvage procedures and moreover those with minimal operative complications will result in better, natural long-term intermediary measure outcome with a resultant delay in joint replacement procedure which is in the better interest of the patient. Keywords: Anterior hip dislocation, open reduction, obturator inferior type, neglected dislocation, Anterolateral approach.

Precision and accuracy of pre-surgical planning of non-cemented total hip replacement with calibrated digital images and acetates

Background When approaching a joint replacement procedure, pre-surgical planning is essential to predict an accurate estimation of implant size and position. There are currently two methods to achieve it, analog and digital. The present study aims to demonstrate how the hybrid technique is accurate and precise for pre-surgical planning in a non-cemented total hip replacement. Methods Concordance-type study is used against a gold standard, as well as inter- and intra-observer consistency evaluation of two orthopedic surgeons and two orthopedic surgery residents. Accuracy was calculated with the intra-class correlation coefficient (ICC). Afterwards, the same calculation was done considering a margin of error with one size more and one less. Results Thirty-eight patients were included in the study: 19 women and 19 men. Twenty-two prostheses (57.89%) were right-sided and 16 were left (42.11%). Twelve prostheses (31.57%) were Stryker and 26 Johnson & Johnson (68.43%). Acetabular cup correlation compared with the gold standard was moderate: ICC reported 0.45 (95% CI, 0.15–0.76). When adjusted by ± 1 size, ICC was 0.48 (95% CI, 0.18–0.79). On the other hand, results from the femoral stem reported ICC 0.85 (95% CI, 0.07–0.98). When adjusted by ± 1 size, ICC was 0.86 (95% CI, 0.06–0.99). Conclusions Hybrid templating is a reliable substitute for analog or digital planning. It is quick, inexpensive, accurate, and better results are observed in the femoral component regardless the level of expertise of the evaluator. Level of evidence Grade IV

Defibrillation success after subcutaneous implantable cardioverter-defibrillator generator replacement is not affected by impedance increase

Funding Acknowledgements Type of funding sources: None. Background Routine defibrillation testing during implant and replacement of the subcutaneous implantable cardioverter-defibrillator (S-ICD) is recommended per current guidelines. Recently, concerns have been raised about an increase in shock impedance and consequent shock failure during defibrillation testing in S-ICD patients undergoing a generator replacement. Purpose We aim to describe the defibrillation success rate in relation to the shock impedance in patients undergoing S-ICD generator replacement in our large tertiary center. Methods In this retrospective analysis, data from replacement procedures were collected from all patients who underwent an S-ICD generator replacement in our center from June 2014 to December 2020. Defibrillation testing was performed with at least one shock of ≤65J, and a successful shock was defined as terminating the ventricular arrhythmia within 5 seconds after the shock. Results A total of 133 patients underwent an S-ICD generator replacement, 5.8 ± 0.9 years after initial implant. Reasons for replacement were: reaching of elective replacement indicator (n = 119), early battery depletion (n = 9), complaints of generator pocket (n = 3) and device malfunction (n = 2). Defibrillation testing was performed in 111 patients (86.5%) undergoing a replacement procedure. Shock impedance data from both the implant and replacement procedure were available in 101 patients. The median shock impedance of these patients during their replacement procedure was significantly higher than during their implant, 79Ω (IQR 66-94) and 66Ω (IQR 57.5-81) respectively (Z = -5.552, p &lt; 0.001). Despite the higher shock impedance, first shock during defibrillation testing was successful in 105/111 patients (94.6%), with a success rate of 97.3% after two attempts. In the remaining three patients, the ventricular arrhythmia could only be terminated with a 80J shock. This was the case during both their initial implant and their replacement procedure. Shock impedance increase between implant and replacement was not significantly higher in patients with a successful first shock compared to patients with an unsuccessful first shock (Δ+11.1 ± 20.0Ω versus Δ+12.7 ± 27.6Ω, p = 0.86). Conclusion In this large retrospective analysis, we have shown a first shock success rate during S-ICD generator replacement of 94.6%, which is similar to the success rate of defibrillation testing after initial implant. After multiple attempts, defibrillation testing success rate was 100%. Even though the median shock impedance during replacement was significantly higher than during the initial implant, there was no difference in impedance increase in patients with a successful shock compared to patients with an unsuccessful shock. Abstract Figure. Defibrillation success

Minimally invasive redo aortic valve replacement with a sutureless valve implant

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.