Repair of post-infarction left ventricular free wall rupture using an extracellular matrix patch

Several techniques for surgical treatment of acute or subacute left ventricular free wall rupture (LVFWR) have been described using a sutured or sutureless patch with different currently available materials. We present a case report of a 50-year-old male with acute LVFWR, who was treated with a simple surgical technique using an ‘off-pump' epicardially sutured LV patch consisting of an acellular xenogeneic extracellular matrix (ECM). ECM patches are structurally more surgeon-friendly and have shown to be bioactive, and capable of activating remodelling and even tissue regeneration. Compared with conventional pericardial patches, the advantage of this material is excellent pliability and very easy stitching owing to the thin composition of the material. In addition, and most importantly, in case of complex structural reconstructions, the patch is highly tear-proo

Repair of post-infarction left ventricular free wall rupture using an extracellular matrix patch

Several techniques for surgical treatment of acute or subacute left ventricular free wall rupture (LVFWR) have been described using a sutured or sutureless patch with different currently available materials. We present a case report of a 50-year-old male with acute LVFWR, who was treated with a simple surgical technique using an 'off-pump' epicardially sutured LV patch consisting of an acellular xenogeneic extracellular matrix (ECM). ECM patches are structurally more surgeon-friendly and have shown to be bioactive, and capable of activating remodelling and even tissue regeneration. Compared with conventional pericardial patches, the advantage of this material is excellent pliability and very easy stitching owing to the thin composition of the material. In addition, and most importantly, in case of complex structural reconstructions, the patch is highly tear-proof

What will surgical coronary revascularization look like in 25 years?

PURPOSE OF REVIEW Coronary artery bypass grafting evolved in incremental but significant steps since its introduction. Here, we provide an update on operative techniques, choice of conduits, patient selection/decision-making and primary and secondary prevention measures with potential of influencing the future of coronary artery bypass grafting (CABG) surgery. RECENT FINDINGS Associated mortality of off-pump CABG (OPCAB) procedures performed in high-volume OPCAB centers (≥164 cases per year) and by experienced surgeons (≥48 cases per year) was reduced compared with on-pump CABG with two or more grafts suggesting a volume-based dependency of outcomes in CABG procedures with high-technical complexity. Ten-year results from the recent Arterial Revascularization Trial showed no significant between-group difference for the primary and secondary outcome. Total arterial revascularization using composite bilateral internal mammary artery-Y-conduits through a limited access mini-thoracotomy was not only shown to be feasible but a safe and reproducible procedure with excellent midterm outcomes. The most recent Randomized Trial of Endoscopic or Open Vein-Graft Harvesting for Coronary-Artery Bypass (REGROUP) trial demonstrated no significant difference between open vein-graft harvesting and endoscopic vein-graft harvesting in the occurrence of major adverse cardiac events. SUMMARY Adherence to the most recent guidelines on myocardial revascularization is a key component for providing state-of the CABG surgery. Trends to lesser invasiveness in surgical coronary revascularization will gain momentum and is expected - with further improvements - to be the mainstay of future surgical coronary revascularization strategies

Multiarterial grafting in coronary artery bypass grafting

ISSN:1522-9645ISSN:0195-668

Results of transvenous lead extraction of coronary sinus leads in patients with cardiac 4,703 resynchronization therapy

BACKGROUND: The need for transvenous lead extraction procedures of coronary sinus (CS) leads is increasing due to rising numbers of implanted cardiac resynchronization therapy devices during the past decade. METHODS: From January 2009 to June 2013, 27 CS leads were scheduled for extraction in 27 patients (mean age (63.1±14.6) years). Indications for lead extraction were infection in 13 and lead dysfunction in 14 cases. Isolated extraction of CS leads was performed in eight, extraction of multiple leads in 19 cases. Among leads with an implant time of ≥12 months (n = 19) mean implant duration (MID) was (46.4±15.2) (12-76) months. Groups were formed depending on infectious or non-infectious indications (INF vs. Non-INF), and the use or non-use of extraction tools (ET1 vs. ET0). RESULTS: Among patients with an implant duration of ≥12 months, complete procedural success was 94.7% and clinical success 100%. Operative mortality was zero. In the INF versus NON-INF groups complete procedural success (100% vs. 91.7%, P = 0.43), mean number of required extraction tools (0.7 (0-2) vs. 0.9 (0-3), P = 0.65) and MID (49.1±15.0 vs. 44.7±15.8, P = 0.83) did not differ significantly. Comparing the groups ET1 and ET0 showed no significant differences in complications (n = 1 vs. n = 1, P = 0.81) and MID (47.0±17.5 vs. 45.5±12.6, P = 0.71). CONCLUSIONS: In specialized centers transvenous lead extraction of coronary sinus leads with a mean implant duration of almost four years can be performed safely and effectively. Neither non-infectious indications nor the use of extraction tools negatively affected the outcome of the procedure

Surgical techniques for left atrial appendage exclusion

The increasing prevalence of atrial fibrillation with the aging population and its associated major morbidity and mortality due to thromboembolic stroke have resulted in intensive research on stroke prevention or stroke risk reduction strategies. Several surgical techniques for left atrial appendage (LAA) occlusion have evolved over the past decades. Surgeons have been using different techniques leading to highly variable and, in particular, poor data on outcomes. LAA closure is performed either as a concomitant procedure during open-heart surgery or as a stand-alone surgical procedure as part of minimally invasive (mini-thoracotomy or thoracoscopy) arrhythmia surgery. Data on the safety and feasibility of surgical LAA occlusion are derived mainly from nonrandomized case series, observational and cohort studies, or registries with mostly inconclusive and conflicting results. Increased awareness of the high failure rates in attaining complete LAA occlusion, thus avoiding poor surgical techniques (e. g., simple suture ligation, endocardial suturing etc.), and the availability of newer devices (e. g., AtriClip device) have recently led to improved surgical results in the literature. If further validated in large-scale studies, these recent promising developments in the field of surgical LAA treatment seem to offer alternatives for patients ineligible for oral anticoagulation therapy with vitamin K antagonists or newer non-vitamin-K-dependent oral anticoagulants