Abstract


When the original monograph on valvular prostheses was published in Surgical Technology International, back in 1993, transcatheter technology had not yet been invented. These techniques have been gradually revealed in subsequent issues. When we first considered writing a paper that described both surgical and transcatheter prosthesis, we realized that such a combined paper would be impractically large. Therefore, we decided to split our survey into more than one paper. This paper seeks to address the paucity of information available regarding transcatheter aortic valve implantation (TAVI) and similar devices. This publication may serve as a reference point for critically organizing information on an evolving topic.
The following article deals with the large number of transcatheter devices related to valvular and ventricular pathologies: TAVI for the aortic and mitral valves, with a focus on indications, techniques and complications, as well as specific aortic devices, and devices to treat mitral regurgitation with non-conventional access. Every effort has been made to make the content relevant and up-to-date, which proved to be particularly challenging due to the continuous technological evolution which characterizes this field.

Abstract


Currently, there is a wide range of commercially available endografts for infrarenal abdominal aortic aneurysm (AAA) repair. Results of long-term follow up after endovascular aneurysm repair (EVAR) are limited. Thereby, the durability of these endografts and the difference between manufacturers is not fully clear.
In this review, studies with mid- and long-term results, with a minimum median follow up of 36 months per endograft, were included describing results with Cook Zenith® Flex® endograft (Cook Medical Inc., Bloomington, Indiana) (n=6), Cordis Corporate INCRAFT® (Cordis Corporation, Freemont, California) (n=1), Gore® EXCLUDER® (W.L. Gore & Associates Inc., Flagstaff, Arizona) (n=3), Medtronic Endurant™ (Medtronic plc, Santa Rosa, California) (n= 6), and Vascutek Anaconda™ (Vascutek Ltd., Inchinnan, Scotland) (n=2).
The assisted technical success varied between 83% and 100%, and the perioperative mortality, early reintervention, and early conversion rates were comparable for the studied endografts. At three-year follow up, the freedom from AAA-rupture and AAA-related death varied between 98% and 100%. The results demonstrated an increasing complication and reintervention rate over time. When adhering to the instruction for use, minor differences were seen during follow up between the endografts. Latest generation endografts continue to have good postoperative results; the reintervention-rate of 10–20% over time mandates an ongoing close patient follow up. The choice of a specific design depends on native patient anatomy and the experience of the implanting surgeon.

Abstract


We report a patient who presented with multiple rib fractures after falling off a horse and was initially managed medically. Several weeks later, the patient returned to the hospital complaining of dyspnea on exertion. Physical exam revealed severe chest wall malformation and imaging revealed moderate hemothorax and complete collapse of the right lower lobe. Considering the likelihood that this patient’s multiple ribs fractures contributed to the hemothorax and trapped lung, the patient underwent surgical evacuation of the hemothorax followed by rib fixation of ribs three through six. The procedures were performed using both intra-thoracic and extra-thoracic video-assisted thoracoscopic surgery (VATS) and did not require the use of thoracotomy incision or open exposure of the thoracic cavity. This case report suggests that this operative technique is a viable option for delayed presentation of multiple rib fractures and complex sequela associated with this pathology.