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SURGICAL TECHNOLOGY INTERNATIONAL XV.

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$175.00

 

STI XV contains 35 articles with color illustrations.

 

Universal Medical Press, Inc.

San Francisco, 2006, ISBN: 1-890131-11-3

 

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Cardiovascular Surgery

 

Advanced Technologies for Cardiac Valvular Replacement, Transcatheter Innovations and Reconstructive Surgery 
W. R. Eric Jamieson, M.D., F.R.C.S. (C.), F.A.C.S., F.A.C.C., University of British Columbia, St. Paul's Hospital, Vancouver General Hospital, Vancouver, Canada 

 

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Abstract
Since the 2002 Surgical Technology International monograph on valvular prostheses, there have been significant developmental and investigative advances. Aortic bioprostheses and mechanical prostheses have undergone design changes to optimize hemodynamics and prevent patient-prosthesis mismatch to have a potential satisfactory influence on survival. There has been continual technological improvements striving to bring forward advances that improve the durability of bioprostheses and reduce the thrombogenicity of mechanical prostheses. There also has been a continuance to preserve biological tissue with glutaraldehyde, rather than clinically evaluate other cross-linking technologies, by controlling or retarding calcification with therapies to control phospholipids and residual aldehydes. The techniques of mitral valve reconstruction have now been well established and new annuloplasty rings have been designed for the potential of maintaining the anatomical and physiological characteristics of the mitral annulus. Several objectives exist for annuloplasty, namely remodeling of the length and shape of the dilated annulus, prevention of dilatation of the annulus, and support for the potentially fragile area after partial-leaflet resection. Currently, there exists an emergence of catheter-based therapies for management of aortic stenosis and mitral regurgitation. For management of selected populations with critical aortic stenosis, techniques for aortic valve substitution have been developed for both antegrade and retrograde catheter techniques, as well as apical transventricular implantation. Mitral regurgitation has been addressed by experimental transcoronary sinus, stent-like devices and transventricular, edge-to-edge leaflet devices. The devices, descriptions and pictorial images comprise this monograph.

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Mitral Valve: Toward Complete Repairability 
Gerald M. Lawrie, M.D., F.A.C.S., F.A.C.C., F.A.H.A., The Methodist DeBakey Heart Center, Texas Surgical Associates, Houston, TX 

 

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Abstract
During the last 50 years, there has been an exponential increase in our understanding of the structure and function of the mitral valve in health and disease. Large numbers of patients have undergone mitral-valve reparative procedures worldwide with variable results. In our initial 10-year experience in which traditional techniques were used for repair of mitral regurgitation, a 70% success rate was achieved. In 1995, a critical reappraisal of the common causes of failure to repair, or failure of repair and developed improved surgical approaches for these patients began. The conditions addressed were massive bileaflet prolapse ("Barlow's valves"); anterior leaflet prolapse; multisegment chordal failure; commissural accessory leaflet tissue prolapse; and leaflet destruction by endocarditis. A widely applicable standard technique was developed that the author and colleagues called the "American Correction." It emphasizes chordal replacement with polytetrafluoroethylene (PTFE) artificial chordae, importance of the line of apposition of the leaflets, and importance of simultaneous dynamic adjustment of the chordal length and anteroposterior dimension of the mitral annulus. In addition, use of multiple techniques in 30% of patients to complete the repair has been emphasized. These techniques resulted in a 90% repairability rate for all pathologies and 100% for myxomatous-mitral insufficiency. These techniques also have led to a decline in reoperation rates, and improved long-term durability. Continued evaluation with intraoperative and postoperative three-dimensional (3-D) echo provides further insights and refinement of mitral-repair techniques.

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Early Mobilization after Aortic Valve Surgery 
Idar Kirkeby-Garstad, M.D.; Olav F Münter Sellevold, M.D., Ph.D., St. Olav University Hospital, Trondheim, Norway 

 

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Abstract
In recent years, the focus in peri-operative care of cardiac patients has shifted from trying to create a stress-free environment to hasten the recovery of patients by providing early extubation, early mobilization, and enteral nutrition. Fast-track cardiac surgery has therefore made a paradigm shift in postoperative care. However, evidence on the safety of early postoperative mobilization in high-risk groups like aortic valve replacement surgery is lacking. Physiological evidence from controlled studies in patients undergoing aortic valve replacement (AVR) showed that heart rate increases and stroke volume falls with maintenance of cardiac output. However, the increase of 50% to 60% of oxygen consumption during mobilization is covered by increased oxygen extraction, resulting in marked mixed venous oxygen desaturation. These physiological changes during postoperative mobilization were also seen in CABG patients. The mobilization pattern was also maintained on the second day after surgery. No serious side effects were observed in the controlled trials of mobilization of AVR patients after cardiac surgery. Over a 13-year period, we have mobilized more than 1200 AVR patients. No serious situations have occurred during or in direct connection to mobilization.

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Isthmus Endoprosthesis Stent-Graft Treatment: Implantation of Relay™ Dedicated Device
Alessandro S. Bortone, M.D., Ph.D., F.E.S.C., Institute of Cardiac Surgery; Emanuela de Cillis, M.D., Institute of Cardiac Surgery; Donato D'Agostino, M.D., Institute of Cardiac Surgery; Michele Sciascia, M.S., Institute of Cardiac Surgery; Luigi de Luca Tupputi Schinosa, M.D., Institute of Cardiac Surgery, University of Bari School of Medicine, Bari, Italy

 

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Abstract
Among the 123 patients treated in our department by endovascular stent graft, 113 (91.8%) were identified as having involvement of the isthmus. Therefore, the incorrectly defined descending aortic disease is essentially a pathology of the isthmus that represents the distal portion of the arch. The key to the treatment of all types of aortic lesions rests on understanding the morphology of this region gifted with a "double S" configuration. Current thoracic devices are noncompliant systems and should be modified greatly, taking into account that the media of the aorta has a semi-compliant behavior. The resultant of power transmission is oriented at 45° and produces a transmural radial force that animal implantation has demonstrated to be a torsional movement. The improvements in new devices actually result in a new generation of endoprostheses that seem to be closely related to the anatomy of the patient by increasing the conformability and, therefore, we expect an increase in durability. To test these features, we have studied a new stent graft in different settings of thoracic aortic disease. The new device should conform to current standards while simultaneously transmitting torsional forces. The dedicated delivery system should be arch-compatible, flexible but sufficiently rigid, and able to be three-dimensionally oriented. Moreover, the new stent graft should follow the three-dimensional anatomy of the "double S" configuration of the isthmus area and thus reduce the mismatch between the aorta and the device itself.

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