Our experience with aortic valve repair with a remodeling technique, extraaortic ring implantation and root replacement

Objective: Aortic valve replacement (AVR) is still the most commonly used therapeutic option for patients suffering from AR. Aortic valve repair (AVRep) is an attractive alternative method, since it avoids the risks of prosthesis-related complications.1-3 We would like to present our experience with the Yacoub root remodeling, valve sparing technique with the extraaortic expansible ring. Patients and Methods: Between November 2014 and July 2019, a total of 79 patients (52.6±13.3 years; 15.2% female, EuroScore II of 3.15%±2) underwent AVRep, 12 due to isolated cusp malcoaptation and 67 associated with aortic root dilatation. Reconstruction was done with the Coroneo Extraaortic Ring (27 (25-31)), and the Gelweave graft (28 (26-32)). 44 patients had a tricuspid valve, 33 patients had a bicuspid valve, and 2 patients had an unicuspid valve. Concomitant procedures included Mvrep and TVrep in 4 patients, CABG in two patents. Aortic arch was replaced in two patients, two patients underwent hemiarch replacement, and two patients had aortic arch replacement with stented conduit and placement of stent in descending thoracic aorta (EVITA stent graft Jotec GmbH). Echocardiography was used to determine AR severity grade preoperatively, during immediate post-operative period (within 7 days from operation) and at early follow-up. Results: In postoperative follow-up no patients died. Freedom from reoperation was 88% (10/79) and there were 2 patients reoperated due to early postoperative regurgitation, one patient was reoperated due to AI after two years, and one was operated due to pseudoaneurysm formation after 2.5 years. A significant decrease in LV end-diastolic diameter was observed (LVEDD) (60mm preoperatively, 53 mm postoperatively) with further decrease at early follow-up. At follow up none of the patients had major AR (AR0=61, AR1+=14, AR2+=4). Conclusions: We have proved that AVRep is a good alternative for patients with aortic insufficiency and leads to LV reverse remodeling with comparable results in terms of LVEDD and LVEF immediately post-operatively and at early follow up. It is feasible to use this technique in tricuspid, bicuspid, as well as unicuspid valves with excellent results

Managment of poststernotomy complications by vacuum therapy

UVOD: Terapija rane podtlakom (eng. „Negative pressure wound therapy“ ; „NPWT“ ili „Vacuum assisted closure“; V.A.C.) široko je rasprostranjena terapijska metoda koja, različitim mehanizmima potiče cijeljenje akutnih i kroničnih rana. Terapija rane negativnim tlakom svestrana je metoda te je primjenjiva kod različitih rana, od dijabetičkog ulkusa, dekubitalnih rana, zbrinjavanja abdominalnih compartment sindroma do zbrinjavanja sternalnih rana u kardiokirurškim operacijama. Prilikom kardiokirurških operacija izvođenjem medijalne sternotomije moguća je komplikacija duboke ili površinske infekcije sternalne regije. Komplicirane duboke sternalne infekcije povezane su visokim morbiditetom i mortalitetom te se suvremena metoda terapije negativnim tlakom pokazala kao kvalitetan način liječenja. ---- METODE: Pretražili smo PubMed literaturu koristeći ključne riječi „Vaccum assisted closure“ , „Negative pressure wound therapy“ , „Poststernotomy wound complications“ , „sternal wound infections“, „Poststernotomy wound dehiscence“. Pretežno smo koristili članke u prethodnih 15 godina. ----- REZULTATI: Brojni radovi su objavljeni na temu zbrinjavanja komplikacija medijalne sternotomije kod kardiokirurških operacija. Danas se ta metoda pokazala najučinkovitijom u zbrinjavanju dubokih sternalnih infekcija gdje je zabilježen značajno smanjen mortalitet i morbiditet, uz smanjenje broja reinfekcija a samim time i potrebe za hospitalizacijom te uštedom novčanih sredstava u zdravstvu. ----- ZAKLJUČAK: Zbrinjavanje komplikacija sternalnih rana terapijom negativnim tlakom se pokazala vrlo učinkovitom metodom. U usporedbi s prijašnjim metodama zbrinjavanja zbog svog specifičnog načina djelovanja, jednostavne upotrebe i umanjenih troškova u odnosu na konvencionalne metode terapija negativnim tlakom se nametnula kao terapija izbora zbrinjavanja poststernotomijskih komplikacija.BACKGROUND: Negative pressure wound therapy (NPWT) is widely used method which promotes healing of acute and chronic wounds. It is a versatile method used for treating all kinds of wounds from diabetic ulcers, bedsores, management of abdominal compartment syndrome to poststernotomy complications in cardiac surgery. Complications after median sternotomy include superficial and deep sternal wound infections. Complicated deep sternal infections are associated with high morbidity and mortality and the NWPT has been showing great results. ----- METHODS: We searched PubMed literature using the following key words: „Vacuum assisted closure“, „Negative pressure wound therapy“, „Poststernotomy wound complications“ , „Sternal wound infections“, „Poststernotomy wound dehiscence“. We mainly used articles in the past fifteen years. ----- RESULTS: There are numerous papers published regarding NPWT use in management medial sternotomy complications after cardiac surgery. Today this method has been shown to be efficient in management of poststernotomy complications where it showed significant reduction in mortality and morbidity,and reduced reinfections which reduced hospital treatment costs. ----- CONCLUSION: Management of poststernotomy complications by vacuum therapy has been shown to be very efficient. In comparison to conventional methods because of its specific mode of action, simple use and cost reduction compared to other methods it has imposed as the therapy of choice for management of poststernotomy complications

Managment of poststernotomy complications by vacuum therapy

UVOD: Terapija rane podtlakom (eng. „Negative pressure wound therapy“ ; „NPWT“ ili „Vacuum assisted closure“; V.A.C.) široko je rasprostranjena terapijska metoda koja, različitim mehanizmima potiče cijeljenje akutnih i kroničnih rana. Terapija rane negativnim tlakom svestrana je metoda te je primjenjiva kod različitih rana, od dijabetičkog ulkusa, dekubitalnih rana, zbrinjavanja abdominalnih compartment sindroma do zbrinjavanja sternalnih rana u kardiokirurškim operacijama. Prilikom kardiokirurških operacija izvođenjem medijalne sternotomije moguća je komplikacija duboke ili površinske infekcije sternalne regije. Komplicirane duboke sternalne infekcije povezane su visokim morbiditetom i mortalitetom te se suvremena metoda terapije negativnim tlakom pokazala kao kvalitetan način liječenja. ---- METODE: Pretražili smo PubMed literaturu koristeći ključne riječi „Vaccum assisted closure“ , „Negative pressure wound therapy“ , „Poststernotomy wound complications“ , „sternal wound infections“, „Poststernotomy wound dehiscence“. Pretežno smo koristili članke u prethodnih 15 godina. ----- REZULTATI: Brojni radovi su objavljeni na temu zbrinjavanja komplikacija medijalne sternotomije kod kardiokirurških operacija. Danas se ta metoda pokazala najučinkovitijom u zbrinjavanju dubokih sternalnih infekcija gdje je zabilježen značajno smanjen mortalitet i morbiditet, uz smanjenje broja reinfekcija a samim time i potrebe za hospitalizacijom te uštedom novčanih sredstava u zdravstvu. ----- ZAKLJUČAK: Zbrinjavanje komplikacija sternalnih rana terapijom negativnim tlakom se pokazala vrlo učinkovitom metodom. U usporedbi s prijašnjim metodama zbrinjavanja zbog svog specifičnog načina djelovanja, jednostavne upotrebe i umanjenih troškova u odnosu na konvencionalne metode terapija negativnim tlakom se nametnula kao terapija izbora zbrinjavanja poststernotomijskih komplikacija.BACKGROUND: Negative pressure wound therapy (NPWT) is widely used method which promotes healing of acute and chronic wounds. It is a versatile method used for treating all kinds of wounds from diabetic ulcers, bedsores, management of abdominal compartment syndrome to poststernotomy complications in cardiac surgery. Complications after median sternotomy include superficial and deep sternal wound infections. Complicated deep sternal infections are associated with high morbidity and mortality and the NWPT has been showing great results. ----- METHODS: We searched PubMed literature using the following key words: „Vacuum assisted closure“, „Negative pressure wound therapy“, „Poststernotomy wound complications“ , „Sternal wound infections“, „Poststernotomy wound dehiscence“. We mainly used articles in the past fifteen years. ----- RESULTS: There are numerous papers published regarding NPWT use in management medial sternotomy complications after cardiac surgery. Today this method has been shown to be efficient in management of poststernotomy complications where it showed significant reduction in mortality and morbidity,and reduced reinfections which reduced hospital treatment costs. ----- CONCLUSION: Management of poststernotomy complications by vacuum therapy has been shown to be very efficient. In comparison to conventional methods because of its specific mode of action, simple use and cost reduction compared to other methods it has imposed as the therapy of choice for management of poststernotomy complications

Managment of poststernotomy complications by vacuum therapy

UVOD: Terapija rane podtlakom (eng. „Negative pressure wound therapy“ ; „NPWT“ ili „Vacuum assisted closure“; V.A.C.) široko je rasprostranjena terapijska metoda koja, različitim mehanizmima potiče cijeljenje akutnih i kroničnih rana. Terapija rane negativnim tlakom svestrana je metoda te je primjenjiva kod različitih rana, od dijabetičkog ulkusa, dekubitalnih rana, zbrinjavanja abdominalnih compartment sindroma do zbrinjavanja sternalnih rana u kardiokirurškim operacijama. Prilikom kardiokirurških operacija izvođenjem medijalne sternotomije moguća je komplikacija duboke ili površinske infekcije sternalne regije. Komplicirane duboke sternalne infekcije povezane su visokim morbiditetom i mortalitetom te se suvremena metoda terapije negativnim tlakom pokazala kao kvalitetan način liječenja. ---- METODE: Pretražili smo PubMed literaturu koristeći ključne riječi „Vaccum assisted closure“ , „Negative pressure wound therapy“ , „Poststernotomy wound complications“ , „sternal wound infections“, „Poststernotomy wound dehiscence“. Pretežno smo koristili članke u prethodnih 15 godina. ----- REZULTATI: Brojni radovi su objavljeni na temu zbrinjavanja komplikacija medijalne sternotomije kod kardiokirurških operacija. Danas se ta metoda pokazala najučinkovitijom u zbrinjavanju dubokih sternalnih infekcija gdje je zabilježen značajno smanjen mortalitet i morbiditet, uz smanjenje broja reinfekcija a samim time i potrebe za hospitalizacijom te uštedom novčanih sredstava u zdravstvu. ----- ZAKLJUČAK: Zbrinjavanje komplikacija sternalnih rana terapijom negativnim tlakom se pokazala vrlo učinkovitom metodom. U usporedbi s prijašnjim metodama zbrinjavanja zbog svog specifičnog načina djelovanja, jednostavne upotrebe i umanjenih troškova u odnosu na konvencionalne metode terapija negativnim tlakom se nametnula kao terapija izbora zbrinjavanja poststernotomijskih komplikacija.BACKGROUND: Negative pressure wound therapy (NPWT) is widely used method which promotes healing of acute and chronic wounds. It is a versatile method used for treating all kinds of wounds from diabetic ulcers, bedsores, management of abdominal compartment syndrome to poststernotomy complications in cardiac surgery. Complications after median sternotomy include superficial and deep sternal wound infections. Complicated deep sternal infections are associated with high morbidity and mortality and the NWPT has been showing great results. ----- METHODS: We searched PubMed literature using the following key words: „Vacuum assisted closure“, „Negative pressure wound therapy“, „Poststernotomy wound complications“ , „Sternal wound infections“, „Poststernotomy wound dehiscence“. We mainly used articles in the past fifteen years. ----- RESULTS: There are numerous papers published regarding NPWT use in management medial sternotomy complications after cardiac surgery. Today this method has been shown to be efficient in management of poststernotomy complications where it showed significant reduction in mortality and morbidity,and reduced reinfections which reduced hospital treatment costs. ----- CONCLUSION: Management of poststernotomy complications by vacuum therapy has been shown to be very efficient. In comparison to conventional methods because of its specific mode of action, simple use and cost reduction compared to other methods it has imposed as the therapy of choice for management of poststernotomy complications