Staged Concept for Treatment of Severe Postsaphenectomy Wound Infection

The saphenous vein remains the most commonly used conduit in coronary artery bypass surgery. Vein harvest is a critical component with significant morbidity associated with leg wounds from open technique. Occurring complications are hematoma, postoperative pain, skin changes, neuropathy, and septic or nonseptic wound complications. Within the context of a recent case, we present our approach to postsaphenectomy wound management

Information technology in management personnel on the example of KC "Jobs"

Analysis of the workings and personnel decisions in the field of human resource management. They are inextricably linked to the processes of information processing. The higher the effect of the use of personnel information, the more objective decisions will be made by the heads of a wide variety of human resources issues. In this regard, there is a need in the compilation and dissemination of the experience gained in the application of modern technologies, as well the creation of new software products. Consideration of "human process management" module. It is designed to automate the management processes in terms of the conduct of personnel information in the context of positions and employees in order to provide the head of information for management decision making and carrying out related activities. Consideration of the positive and negative sides of the module, as its distinctivefeatures

Transapical aortic valve implantation with a self-expanding anatomically oriented valve

Aims The Medtronic Engager™ aortic valve bioprosthesis is a self-expanding valve with support arms facilitating anatomically correct positioning and axial fixation. Valve leaflets, made of bovine pericardium, are mounted on a Nitinol frame. Here, we report the first in man study with this new implant (Trial Identifier NCT00677638). Methods and results Thirty patients (mean age 83.4 ± 3.8 years; 83% female) with tricuspid aortic valve stenosis were included in the study. Mean logistic EuroSCORE was 23.4 ± 11.9. Mean aortic annulus diameter was 21.8 ± 1.4 mm. For this study, the Engager was available in only one size (23 mm), to fit aortic annuli of 19-23 mm. Standard transapical valve implantation was performed using predilation of the aortic valve and rapid ventricular pacing during ballon valvuloplasty and most valve deployments. Accurate valve placement was achieved in 29/30 cases (97%). Post-implant peak-to-peak gradient was 13.3 ± 9.3 mmHg. In 80% of the patients, no more than grade I paravalvular leakage was observed, in 13% grades I-II and in 3% grade II. Three patients (10%) required permanent pacemaker implantation for higher-degree or complete atrioventricular block. Four dissections (13%) occurred during positioning of the valve and were treated surgically in three cases. Thirty-day and in-hospital mortality were 20% and 23%, respectively, and 6-month survival was 56.7%. No structural failure occurred for up to 1 year. Conclusion This series established the feasibility of implanting a novel self-expanding transapical aortic valve prosthesis predictably into an anatomically correct position. Observed complications led to complete redesign of the delivery system for upcoming clinical studies with the goal of establishing safety and performanc

Risk Profile and 3-Year Outcomes From the SYNTAX Percutaneous Coronary Intervention and Coronary Artery Bypass Grafting Nested Registries

ObjectivesThe aim of this study was to evaluate the use of percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) in “real-world” patients unsuitable for the alternative treatment.BackgroundNo data are available on the risk profile and outcomes of patients that can only undergo PCI or CABG.MethodsIn the SYNTAX (Synergy between PCI with TAXUS and Cardiac Surgery) trial, a multidisciplinary Heart Team reached a consensus on whether PCI and CABG could result in clinical equipoise; if so, the patient was randomized. If not, the patient was enrolled in a CABG-ineligible PCI registry or PCI-ineligible CABG registry. A proportion (60%) of patients in the CABG registry was randomly assigned to be followed up for 5 years. No statistical comparisons were performed between randomized and registry patients. Major adverse cardiac or cerebrovascular event (MACCE) rates are presented as observational only.ResultsA total of 3,075 patients were treated in the SYNTAX trial; 198 (6.4%) and 1,077 (35.0%) patients were included in PCI and CABG registries, respectively. The main reason for inclusion in the CABG registry was too complex coronary anatomy (70.9%), and the main reason for inclusion in the PCI registry was too high-risk for surgery (70.7%). Three-year MACCE was 38.0% after PCI and 16.4% after CABG. Stratification by SYNTAX score terciles demonstrated a step-wise increase of MACCE rates in both PCI and CABG registries.ConclusionsThe SYNTAX Heart Team concluded that PCI and CABG remained the only treatment options for 6.4% and 35.0% of patients, respectively. Inoperable patients with major comorbidities that underwent PCI had high MACCE rates. In patients not suitable for PCI, surgical results were excellent. (SYNTAX Study: TAXUS Drug-Eluting Stent Versus Coronary Artery Bypass Surgery for the Treatment of Narrowed Arteries, NCT00114972

Selective arterialization of a cardiac vein in a model of cardiac microangiopathy and macroangiopathy in sheep

ObjectiveSome patients with significant arteriosclerosis of the heart are not amenable to revascularization of a coronary artery because they have a combination of microangiopathy and significant macroangiopathy. We investigated the benefit of arterialization of a cardiac vein under these circumstances in an acute animal model.MethodsIn the hearts of 8 sheep, microspheres were injected into the left coronary artery; 60 minutes later, a stenosis of the left anterior descending artery was performed. After 45 minutes, retrograde venous revascularization was performed by sewing the left internal thoracic artery to the concomitant vein of the left anterior descending artery in a beating-heart technique. For flow reversal, the vein was ligated proximally to the anastomosis. The efficiency of the bypass graft was evaluated by coronary angiography and flow measurement. Cardiac output, electrocardiography, and mean arterial blood pressure were assessed in each phase of the experiment.ResultsThe ischemic state of the myocardium was confirmed by a significant decrease of cardiac output, stroke volume, and mean arterial blood pressure, and a significant elevation of the ST segment in the electrocardiography. After retrograde venous revascularization was established, cardiac output and stroke volume increased and ST elevations decreased. The grafts showed adequate flow (26.15 ± 2.08 mL/min), and reversed blood flow in the grafted vein was proved by coronary angiography.ConclusionRetrograde venous revascularization is possible and improves cardiac function in a state of acute ischemia caused by a combination of microangiopathy and macroangiopathy

eROSITA Science Book: Mapping the Structure of the Energetic Universe

eROSITA is the primary instrument on the Russian SRG mission. In the first four years of scientific operation after its launch, foreseen for 2014, it will perform a deep survey of the entire X-ray sky. In the soft X-ray band (0.5-2 keV), this will be about 20 times more sensitive than the ROSAT all sky survey, while in the hard band (2-10 keV) it will provide the first ever true imaging survey of the sky at those energies. Such a sensitive all-sky survey will revolutionize our view of the high-energy sky, and calls for major efforts in synergic, multi-wavelength wide area surveys in order to fully exploit the scientific potential of the X-ray data. The design-driving science of eROSITA is the detection of very large samples (~10^5 objects) of galaxy clusters out to redshifts z>1, in order to study the large scale structure in the Universe, test and characterize cosmological models including Dark Energy. eROSITA is also expected to yield a sample of around 3 millions Active Galactic Nuclei, including both obscured and un-obscured objects, providing a unique view of the evolution of supermassive black holes within the emerging cosmic structure. The survey will also provide new insights into a wide range of astrophysical phenomena, including accreting binaries, active stars and diffuse emission within the Galaxy, as well as solar system bodies that emit X-rays via the charge exchange process. Finally, such a deep imaging survey at high spectral resolution, with its scanning strategy sensitive to a range of variability timescales from tens of seconds to years, will undoubtedly open up a vast discovery space for the study of rare, unpredicted, or unpredictable high-energy astrophysical phenomena. In this living document we present a comprehensive description of the main scientific goals of the mission, with strong emphasis on the early survey phases.Comment: 84 Pages, 52 Figures. Published online as MPE document. Edited by S. Allen. G. Hasinger and K. Nandra. Few minor corrections (typos) and updated reference

Comparison of outcomes of minimally invasive mitral valve surgery for posterior, anterior and bileaflet prolapse §

Abstract Objective: We sought to compare the outcomes of minimally invasive mitral valve (MV) surgery for anterior (anterior mitral leaflet, AML), posterior (posterior mitral leaflet, PML) or bileaflet (BL) MV prolapse. Methods: Between August 1999 and December 2007, 1230 patients who presented with isolated AML (n = 156, 12.7%), isolated PML (n = 672, 54.6%) or BL (n = 402, 32.7%) MV prolapse underwent minimally invasive MV surgery. The preoperative mitral regurgitation (MR) grade was 3.3 AE 0.8, left ventricular ejection fraction (LVEF) was 62 AE 12% and mean age was 58.9 AE 13.0 years; 836 patients (68.0%) were male. Mean follow-up time was 2.7 AE 2.1 years, and the follow-up was 100% complete. Results: Overall, the MV repair rate was 94.0% (1156 patients). Seventy-four patients (6.0%) received MV replacement. MV repair for PML prolapse was accomplished in 651 patients (96.9%), for AML in 142 patients (91%) and for BL in 363 patients (90.3%). Repair techniques consisted predominantly of leaflet resection and/or implantation of neochordae, combined with ring annuloplasty. Concomitant procedures were tricuspid valve surgery (n = 56), atrial fibrillation ablation (n = 286) and closure of an atrial septal defect or patent foramen ovale (PFO) (n = 89). The overall duration of cardiopulmonary bypass was 127 AE 40 min and aortic cross-clamp time was 78 AE 33 min. The mean postoperative hospital stay was 11.6 AE 9.7 days for the overall group. Early echocardiographic follow-up revealed excellent valve function in the vast majority of patients, regardless of the repair technique, with a mean MR grade of 0.3 AE 0.5. For the overall group, 5-year survival rate was 87.3% (95% CI: 83.9-90.1) and 5-year freedom from cardiac reoperation rate was 95.6% (95% CI: 94.1-96.7). The log-rank test revealed no significant difference between the three groups regarding long-term survival or freedom from reoperation. Conclusions: Minimally invasive MV repair can be achieved with excellent results. Long-term outcomes and reoperation rates for AML prolapse are not significantly different from PML or BL prolapse.