Right Parasternal Incision: A Uniform Minimally Invasive Approach for Valve Operations

Lazzara, Robert R.; Kidwell, Francis E

doi:10.1016/s0003-4975(97)01074-6

Cited by 12 publications

(8 citation statements)

References 4 publications

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“…O diagnóstico precoce e a intervenção terapêutica, como a ressecção total ou parcial do tecido infectado, são fundamentais para a boa recuperação do paciente. O aparecimento de novas possibilidades intervencionistas (7)(8)(9)(10)(11) deverá levar à melhoria dos resultados, principalmente na prevenção de mediastinite pós-operatória ou de suas recorrências. A diversidade de situações, o estado de saúde prévio do paciente, a alta morbimortalidade dessa complicação, obrigam os pesquisadores de todo o mundo a continuar a busca de novos métodos diagnósticos e terapêuticos, cada vez mais eficazes para debelar essa tão temida complicação, bem como a revisão sistemática dos procedimentos atuais visando o aperfeiçoamento das técnicas e condutas utilizadas.…”

Section: Conclusãounclassified

“…Devido às complicações decorrentes a mediastinite pósoperatória (instabilidade esternal insuficiência respiratória, sepse, entre outras), tem-se indicado procedimentos cirúrgicos menos invasivos à abordagem mediastinal, utilizando-se minitoracotomias com ou sem o auxílio de videotoracoscopia (7,8,9) . Assim, têm sido alcançados baixíssimos índices de morbidade, porém essas e outras técnicas menos invasivas têm suas limitações (10) .…”

Section: Introductionunclassified

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Mediastinite pós-esternotomia longitudinal para cirurgia cardíaca: 10 anos de análise

Souza¹,

Freire²,

Tavares-Neto³

2002

Rev Bras Cir Cardiovasc

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INTRODUÇÃO: mediastinites pós-esternotomia para cirurgia cardíaca não são freqüentes (0,2% a 5,0%), porém, quando surgem, se tornam potencialmente graves. Mesmo com o diagnóstico e tratamento precoces, o prognóstico não é bom, sobretudo se houver sepse e outros agravos à saúde associados. OBJETIVO: rever a casuística de casos de mediastinite. MÉTODO: foram analisados os prontuários de 2.272 pacientes submetidos à cirurgia cardíaca entre 1991 e 2000. Todas as operações foram realizadas através de esternotomia mediana longitudinal e circulação extracorpórea no Hospital João XXIII / Instituto de Cirurgia Cardiovascular da Paraíba de Campina Grande (Paraíba). RESULTADOS: a mediastinite ocorreu, em média, 10 dias após a cirurgia, num total de 37 (1,6%) casos, com taxa de letalidade 21,6% (n=8). A maioria (n=19; 51,4%) dos casos foi em pacientes submetidos a revascularização do miocárdio, seguidos pelos procedimentos valvares (n=13; 35,1%), correções de cardiopatias congênitas (n=4; 10,8%) e aneurisma de aorta ascendente (n=1; 2,7%). Vários fatores de risco foram identificados (obesidade, tempo de permanência hospitalar prolongado, diabetes mellitus, tabagismo, reoperações e cirurgias de emergência), especialmente a permanência (por mais de 72 horas no pré-operatório) em unidade de terapia intensiva. A cultura do exsudato foi positiva em 35 (94,6%) dos 37 pacientes, sendo o Staphylococcus aureus o patógeno mais observado em 17 (48,6%). CONCLUSÕES: a freqüência de mediastinite pós-cirurgias cardíaca, com esternotomia associada, é semelhante à descrita na literatura, não tem diminuído no decorrer dos anos, por isto continua representando um desafio para os cirurgiões e equipes, apesar do arsenal diagnóstico e terapêutico atuais.
INTRODUCTION: Mediastinitis is a rare though potentially fatal complication. The incidence is reported to be between 0.2% and 5.0% and is a major cause of postoperative morbidity. Despite early diagnosis and proper treatment, prognosis is poor because of the chance of mediastinal spread of the infection and poor physical state of these patients. OBJECTIVE: To review the casuistic of mediastinites. METHOD: The records of all 2,272 patients who underwent cardiac surgical procedures between 1991 and 2000 were reviewed. All operations were performed using longitudinal sternotomy and extracorporeal circulation in João XXIII Hospital / Institute of Cardiovascular Surgery of Paraíba in Campina Grande, Paraíba. RESULTS: The complication occurred within, on average, 10 days after operation. In total of 37 (1.6%), 8 (21.6%) deaths occurred. Mediastinitis were reported in 19 (51.4%) cases, in patients submitted to coronary artery bypass grafting, 13 (35.1%) in valve diseases, 4 (10.8%) in congenital cardiopathy corrections and 1 (2.7%) in ascending aortic aneurysm. Several risk factors mediastinitis were identified (obesity, prolonged stay in hospital, diabetes mellitus, smoking, reoperation and emergency surgery), especially the prolonged stay in intensive-care unit for more then 72 hours before cardiac...

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Section: Conclusãounclassified

Section: Introductionunclassified

Mediastinite pós-esternotomia longitudinal para cirurgia cardíaca: 10 anos de análise

Souza¹,

Freire²,

Tavares-Neto³

2002

Rev Bras Cir Cardiovasc

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“…Avoidance of a full sternotomy to plicate the MPA was attempted in one case, with a right parasternal incision as previously described for surgical PVR . However, adequate exposure for plication with patch calcification was not feasible, and the patient underwent a sternotomy for plication with successful hybrid valve delivery.…”

Section: Discussionmentioning

confidence: 99%

Hybrid pulmonary artery plication followed by transcatheter pulmonary valve replacement: Comparison with surgical PVR

Sosnowski

Matella

Fogg

et al. 2016

Cathet Cardio Intervent

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Objective/Background Historically, the sole option for patients with a dysfunctional native right ventricular outflow tract (RVOT) requiring re-establishment of pulmonary competence has been surgical PVR. We sought to compare early outcomes of hybrid pulmonary valve replacement (PVR) combining surgical plication of the main pulmonary artery followed by transcatheter PVR, with a contemporary cohort of surgical PVR patients. Methods Retrospective chart analysis of all patients with a dilated native RVOT eligible for surgical PVR over 36 months was performed. The cohorts included patients with previous tetralogy of Fallot repair (n = 14), and previous intervention for congenital abnormality of the pulmonary valve (n = 7). Results Twenty-one patients with a dysfunctional native RVOT met criteria for PVR; 8 using the hybrid procedure (group 1: age, 31.5 +/- 17.4 years) and 13 with cardiopulmonary bypass (CPB) (group 2: age, 31 +/- 18.4 years). Valve delivery was successful in all patients with no procedural mortality. Group 1 had a lesser requirement for blood products (P =< 0.001) and a trend toward shorter hospital stay and higher post-operative hemoglobin. No patients in group 1 received inotropic support post-operatively compared to 54% of patients in group 2. Mean follow-up was 3.4 months for group 1 and 13.6 months for group 2 with the average peak gradient across the RVOT of 20.1 and 15.1 mm Hg respectively (P = 0.12), all with no more than mild PI. Conclusions Transcatheter hybrid PVR following RVOT plication provides a reasonable alternative to surgical PVR particularly in higher risk cohorts, reducing possible longer-term consequences of repeated runs of CPB. © 2016 Wiley Periodicals, Inc.

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“…Similarly, it may provide mechanical advantage for the surgeon as well (KNECHT et al, 1985;MERKLEY;WAGNER, 1996). Even 86 years after its creation, the Finocchieto retractor is still employed for thoracotomies, and some modifications have been done to suit new surgical techniques, although the same structure of rack and handle remain (ROUX et al, 1995;HALL, 1996;JAIN, 1996;KOLE, 1996;QAQISH et al, 1997;GUNDRY et al, 1998;HAR-SHAI et al, 1998;LAZZAR;KIDWELL, 1998;VAN DE WAL et al, 1998;MASSETTI et al, 1999;GILINOV, 2003). Despite not being his original purpose, it has also been used for ribs spreading in emergency thoracotomy, facilitating the access to the heart and the onset of the internal cardiac massage (ALZAGA-FERNANDEZ; VARON, 2005;BENSON et al, 2005).…”

Section: Introductionmentioning

confidence: 99%

Fast Rib Retractor for Internal Cardiac Massage in Dogs – The Ventura Retractor

Aguiar¹

2017

SCI. ANIM. HEALTH

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Cardiorespiratory arrest is a common affection in small animal practice. Thus, internal cardiac massage has not been addressed with adequate instruments for its realization, which implies slower thoracic inlet through the use of Finochietto retractor. In this way, the aim of this article was to disclose the project of a rib retractor that could decrease the thoracic opening time, properly allowing internal cardiac massage. Ten canine corpses, with corporal mass between tree and 60 kg, were employed, with non-related to thoracic injuries causa mortis. Mechanical efficiency calculation was also accomplished. The Ventura Retractor was capable of decreasing the thoracic opening time, making it easier to execute, thanks to its simple and mechanically efficient design, which can concur to outliving.

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Right Parasternal Incision: A Uniform Minimally Invasive Approach for Valve Operations

Cited by 12 publications

References 4 publications

Mediastinite pós-esternotomia longitudinal para cirurgia cardíaca: 10 anos de análise

Mediastinite pós-esternotomia longitudinal para cirurgia cardíaca: 10 anos de análise

Hybrid pulmonary artery plication followed by transcatheter pulmonary valve replacement: Comparison with surgical PVR

Fast Rib Retractor for Internal Cardiac Massage in Dogs – The Ventura Retractor

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