Treatment of Difficult Sternal Non-union Using the RIA Bone Marrow Harvest System

This video shows a patient who was suffering from manubrium nonunion after a mini aortic valve replacement. The nonunion caused significant pain and clicking. The patient was a heavily built male and CT scanning showed several fragments, which suggested that simple plating would be ineffective. Femoral bone marrow is an ideal medium to induce good union and is used in many other areas of chronic nonunion. The orthopedic department joined the case and harvested bone marrow from the right femur with the Reaming-Irrigation-Aspiration (RIA) system. Two clavicular plates were placed across the area of nonunion to hold the manubrium together until union was achieved. The team was very satisfied with the results. At two months postoperative, the patient was pain free and had a stable union

Prognostic value of mitral regurgitation in patients undergoing left ventricular assist device deployment: a systematic review and meta-analysis

Background: Left ventricular assist devices (LVADs) represent an important therapeutic option for patients progressing to end-stage heart failure. LVAD has previously been shown to have a promising role in improving mitral regurgitation (MR). Nevertheless, the prognostic value of preoperative uncorrected MR in this population remains unclear. Methods: A systematic database search with meta-analysis was conducted of comparative original articles of patients with preoperative mild MR (Grade 0-I) versus moderate-severe MR (Grade II-III) undergoing LVAD implantation, in EMBASE, MEDLINE, Cochrane database, and Google Scholar, from inception to June 2022. Primary outcomes were overall and operative mortality. Secondary outcomes were neurological dysfunction, gastrointestinal bleeding, right heart failure, LVAD thrombosis, and driveline infection. Results: Our search yielded 2228 relevant studies. A total of 19 studies met the inclusion criteria with a total of 11 873 patients. LVAD caused a statistically significant decrease of 35.9% in the number of patients with moderate-severe MR (grade II-III) postoperatively. No significant difference was observed in terms of overall mortality, operative mortality, GI bleeding, LVAD thrombosis, and driveline infection rates between mild and moderate-severe MR. An increased rate of right heart failure was seen among patients with moderate-severe MR, while lower rates of neurological events were also observed. Conclusion: LVAD improves the haemodynamics of the left ventricle, to promote resolution of MR. Nevertheless, the severity of preoperative mitral regurgitation in patients undergoing LVAD deployment does not seem to affect mortality.</p