Surgical Technology International
35th Edition
Contains 55 peer-reviewed articles featuring the latest advances in surgical techniques and technologies.
456 pages
Nov 2019 - ISSN:1090-3941
1 year Institutional Subscription
both electronic and print versions
Cardiothoracic and Vascular Surgery
Latest Advances in Annuloplasty Protheses for Valvular Reconstructive Surgery
Luca Weltert, MD, Heart Surgeon, European Hospital, Professor of Biostatistics, Saint Camillus International University of Health and Medical Sciences (UniCamillus), Rosaria Licitra, MD, Cardiologist and Echographist, Andrea Salica, MD, Heart Surgeon, European Hospital, Francesco Irace, MD, Heart Surgeon, European Hospital, Ruggero De Paulis, MD, Heart Surgeon and Head of Department, European Hospital, Rome, Italy
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This is the third and final part of our update on the latest advances in cardiac valvular replacement. Part 1 was dedicated to cardiac valvular replacement, and Part 2 focused on transcatheter cardiac valvular treatment. This part concerns annuloplasty prostheses for valvular reconstructive surgery. The number of patients undergoing surgical heart valve repair has been increasing, particularly in high-volume centers. Annuloplasty is now considered the gold standard in mitral valve regurgitation repair secondary to degenerative, ischemic and idiopathic dilated cardiomyopathy disease. The techniques of mitral valve reconstruction have been well established, but controversies remain regarding the type of annuloplasty ring to be used. The available annuloplasty rings include rigid, flexible, complete, partial, and semi-rigid/flexible. The choice of annuloplasty ring has been the focus of extensive investigation and debate, but to date it still largely remains a matter of “surgeon’s preference” rather than an evidence-based selection. Functional tricuspid regurgitation was traditionally treated by the classic De Vega annuloplasty, but has since evolved after the development of prosthetic tricuspid annuloplasty. Head-to-head comparisons have demonstrated superior long-term outcomes with device-based annuloplasty compared to suture-based surgery, but the type of ring to be used (flexible versus rigid) has recently been questioned, without reaching definitive conclusions. In contrast to mitral and tricuspid valve repair, aortic repair is more difficult with respect to specific valve features. Annuloplasty is considered to play a key role in controlling aortic regurgitation and preventing recurrence after valve repair. Various modifications of annuloplasty have been advocated (internal/external, with/without ring (suture), rigid/flexible ring). but none of them has become a de facto standard. This paper describes the various rings that are available to help orient surgeons and to serve as a reference for students.
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Endovascular Treatment of No-Stent Zones… Quo Vadis?
Koen Deloose, MD, Head Department of Vascular Surgery, Head Department of Surgery, Kim Taeymans, MD, Vascular Surgeon, Joren Callaert, MD, Vascular Surgeon, Department of Vascular Surgery, az Sint Blasius Dendermonde, Belgium
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Endovascular treatment of peripheral artery disease has recently become more important due to its minimally invasive nature. Elderly patients as well as fragile patients, like diabetics and those with end-stage renal disease, can benefit from this low-morbidity/-mortality treatment. Very successful results have been achieved with percutaneous balloon angioplasty and stenting in the superficial femoral and iliac arteries. In some areas, however, such as the common femoral artery and the popliteal artery, vascular physicians remain somewhat reluctant to use endovascular strategies. Common femoral endarterectomy, the most often used technique for treatment of common femoral artery lesions, has shown very good long-term results, but is associated with relatively high complication rates, such as superficial and deep wound problems and lymph leakage. This article describes less-invasive endovascular alternatives, such as atherectomy, drug-coated balloons and stenting, and their results. The popliteal artery is also difficult to treat in an endovascular manner due to biomechanical forces during bending and stretching of the knee or leg. Thus, we also describe currently available minimally invasive treatment options for the popliteal artery.
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The Use of Transcatheter Devices for Mitral Repair and Replacement
Hanna J. Barnes, BA, Rami O. Tadros, MD, Associate Professor of Surgery, David Octeau, BA, Christopher M. Faries, BA, Jonathan Lee, MD, Annapoorna S. Kini, MD, Professor of Medicine, Gilbert H. L. Tang, MD, MSc, MBA, Associate Professor of Cardiovascular Surgery, Mount Sinai Medical Center, Icahn School of Medicine at Mount Sinai, New York, New York
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Recent advances in device design have resulted in a wide variety of transcatheter treatment options for patients with symptomatic mitral valve disease. Surgery remains the gold standard for patients with symptomatic, primary mitral regurgitation, while transcatheter devices can be considered in higher-risk patients. For secondary mitral regurgitation, optimal medical therapy and cardiac resynchronization are recommended. Recent evidence suggests that transcatheter alternatives may be considered as well. This review will provide an overview of current transcatheter mitral repair and replacement technologies. These include those that mimic open surgical procedures such as edge-to-edge repair, choral replacement, direct annuloplasty, and valve replacement.
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The Radial Artery for Coronary Bypass Grafting: the Fifth Decade
Francesco Nappi, MD, PhD, Centre Cardiologique du Nord de Saint-Denis, Paris, France, Sanjeet Singh Avtaar Singh, MD, Golden Jubilee National Hospital, Glasgow, United Kingdom, University of Glasgow Institute of Cardiovascular and Medical Sciences, Glasgow United Kingdom, Irina Timofeeva, MD, Centre Cardiologique du Nord de Saint-Denis, Paris, France, Christophe Acar, MD, La Pitié Salpetriere Hospital. Paris, France
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Background: In 1989, we reported the use of the radial artery as a second target conduit for coronary artery bypass grafting. However, underpowered randomized trials have reported differences in clinical outcomes between the radial artery and other grafts. As we approach 50 years of experience with radial artery grafting, we reviewed the literature to determine the second-best target vessel for coronary operations.
Methods: An electronic review of the literature with an emphasis on randomized controlled trials, propensity-matched observational series, and meta-analyses identified a large population of patients who received arterial conduit and saphenous vein grafts.
Results: The radial artery has been proven to be reliable as a second target conduit for coronary artery bypass grafting, with outcomes and patency rates superior to those for saphenous vein graft. It has also been proven to be both safe and effective as a third conduit in the territory of the right coronary artery. A paucity of evidence with few comparable series limits the use of the gastroepiploic artery.
Conclusion: In its fifth decade of use, we can definitively conclude that the aorto-to-coronary radial bypass graft is the conduit of choice for coronary operations after the left internal thoracic artery to the left anterior descending artery.
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Diaphragmatic Pacing: Is There a Benefit?
Terra M Hill, MS, University of Kansas, School of Medicine, Kansas City, KS, Osita Onugha, MD, MBA, Providence St. John’s Health Center, John Wayne Cancer Institute, Santa Monica, CA
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The diaphragm is the primary muscle of respiration and its injury can cause diaphragm dysfunction and respiratory deficits. Respiratory compromise has historically been managed with mechanical ventilation, however, its use has also been shown to result in poor functional outcomes. Therefore, stimulation of the phrenic nerve, called diaphragm pacing, has been used to replace and/or delay the need for mechanical ventilation. This article will review the relevant literature on diaphragm pacing, discuss the physiology of diaphragm dysfunction in a variety of patient populations, and address whether diaphragm pacing is a valuable and effective option for treatment of respiratory failure.
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