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

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.

Bicortical Screw and Needle Welded Together as Effective Implant Technique for Immediate Load of SINGLE Tooth in Aesthetic Zone Characterized by Severe Bony Reabsorption: Cases Report

After a long period of time in which submerged implants were used just with delayed load, scientific evidence has led to immediate loading, finally re-evaluating the long lasting experience gotten with one-piece implants. In aesthetic area, if bone is deep and wide, immediate load can be performed with any type of implants, with scarce risk of failure. Situations in which bone is scarce are frequent and impose to choose between performing a suitable technique compatible with immediate loading or renouncing to immediate loading. In our experience, implant technique based on the welding-in-mouth of a titanium needle to main implant is regularly destined to success, because the needle implant, deeply anchored to bone, compensates the lateral forces that normally push the tooth forward. The long lasting experience accrued since over 30 years in our professional offices leads us to suggest this technique as a standard solution while dealing with bone reabsorption in the aesthetic area. We are certain that further studies will confirm our conclusions.

Rehabilitation single tooth loss with screw retained implant crown: Case report

Tooth loss is a common problem in adults. the negative effects of tooth loss are decreased chewing and speech function, reduced aesthetics, and migration of adjacent teeth. Many types of dental prosthetics can be used to prevent these negative effects, such as removable partial dentures, adhesive resin dentures, fixed partial dentures, and dental implants each prosthesis had its advantages and disadvantages. In this case report the clinician will discuss about single tooth implants. The aim of this case report is to provide information about the procedure for placement single tooth implants to the posterior mandibular teeth using the screw retained implant technique.

Non-selective para-hisian stimulation used for QRS normalization guided by non-invasive electrical synchrony method in patients with electrical conduction disorders

Introduction Para-hisian stimulation produces a physiological cardiac activation through normal conduction system. Frequently it is used in patients with no electrical conduction disorders. We developed an implant technique guided by non-invasive electrical synchrony using conventional screw-in leads. Non-selective para-hisian stimulation can normalize electrical conduction disorders. Synchromax is a novel device used to evaluate non-invasive cardiac electrical synchrony. It is easy to understand, fast to obtain, non-invasive and reproducible. Synchromax was analyzed in previous studies and correlated with other methods. Objective Evaluate usefulness and safety of non-selective para-hisian stimulation guided by non-invasive cardiac electrical synchrony method using conventional screw-in leads to normalize electrical conduction disorders. Materials and methods 421 patients with para-hisian stimulation were analyzed retrospectively. 139 patients had different intraventricular and auriculo-ventricular electrical disorders. Non-selective para-hisian stimulation guided by no-invasive electrical synchrony method (Synchromax) was performed in all cases. Synchrony index and curves were analyzed according curves chart. Type 2 curve and index between 0,1 and 0,4 were considered synchronous. Type 8 curve and index more than 0.7 were considered dyssynchronous. Results Mean age 71 years (±7 years). 65,4% males. 30,9% had 2° and 3° grade AV block associated. Patients were divided in 5 groups: 1-Right bundle branch block (RBBB): 43 patients 2-Left bundle branch block (LBBB): 33 patients 3-Brugada Syndrome: 8 patients 4-Left anterior hemi-block (LAHB) 30 patients. 5-RBBB associated with LAHB: 25 patients. QRS normalization was achieved in 87% of the cases using non-selective para-hisian stimulation guided by Synchromax with conventional screw in leads. A ventricular approach was performed during implantation. Electrical synchrony was not solved in 13% of patients mostly in LBBB and RBBB associated with LAHB. Two dislodgments were evidenced. Conclusions Non-selective para-hisian stimulation guided by Synchromax method using conventional screw in leads solved most of intraventricular electrical disorders. It is also safe to use in patients with auriculo-ventricular electrical disorder. Funding Acknowledgement Type of funding source: None

Non-invasive electrical synchrony method to guide para-hisian stimulation implant technique

Introduction Right ventricular apex stimulation solves electrical disorder but electrical disynchrony can be generated. Left bundle branch block results in heart failure and device upgrade is needed in some cases. Para-hisian stimulation generates a physiological cardiac activation through normal conduction system. Sheaths and special leads are used with current techniques. We developed an implantation technique guided by non-invasive electric synchrony using conventional screw-in leads. Synchromax is a novel device used to evaluate non-invasive cardiac electrical synchrony. It is easy to understand, fast to obtain, non-invasive and reproducible. Synchromax was analyzed in previous studies and correlated with other methods. Objective Usefulness and safety of non-invasive cardiac electrical synchrony method using conventional screw-in leads to guide para-hisian device implantation. Materials and methods 421 patients were evaluated. All patients had indication of ventricular stimulation (pacemaker and ICD). Non-invasive electrical synchrony was performed with Synchromax study during the device implantations in all patients. Synchrony index and curves were analyzed. Type 2 curve and index between 0,1 and 0,4 were considered synchronous. Type 8 curve and index more than 0.7 were considered dyssynchronous. Attempt numbers, thresholds, fluoroscopy time and dislodgments were analyzed. Results Mean age 69 years (±8 years). 67,9% males. 421 devices were implanted (334 pacemakes and 87 ICDs). Sick sinus syndrome was the main pacemaker aetiology and dilated cardiomyopathy was in patients with ICD. Conventional screw-in leads were used in all cases. An implant technique was designed. A J-shaped curve with a small perpendicular curve at the tip is performed in the stylet. On average 1,9 attempts were made. Thresholds average 1,2 mV. High thresholds in 4 patients with selective parahisian stimulation. 7 dislodgments was evidenced (1,6%). Fluoroscopy time average 8,4 min. Type 2 curve and index under 0,4 was obtained in 94,5% of cases. Conclusions Para-hisian pacemaker implantation guided by Synchromax method using conventional screw-in leads is safe and useful achieving a physiological stimulation. Few attempts were needed with this new technique. Thresholds were similar to those used in conventional technique. Funding Acknowledgement Type of funding source: None