A combination of hydro-debridement with pulsed lavage and negative pressure wound therapies may enhance outcomes

Deep sternal wound infection (DSWI) with prosthetic graft infection is a rare, though lethal, complication after cardiovascular surgery via median sternotomy. This commentary is a review of a report by Takagi et al. published in the Journal of Cardiac Surgery that reported favorable outcomes in patients with DWSI with prosthetic graft infection treated with an enhanced strategy consisting of hydro-debridement with pulsed lavage and negative pressure wound therapies.</jats:p

Extravascular endoconduit for compromised access route in patients with ruptured thoracic aortic aneurysm

Some patients who undergo thoracic endovascular repair (TEVAR) for a thoracic aortic aneurysm have a compromised or unfavorable access route that requires additional intervention or another access route approach. We experienced a case involving an 80-year-old woman who developed a ruptured thoracic aortic aneurysm with an unfavorable access route characterized by a narrow external artery and severe atherosclerosis. She was severely frail due to a history of fractures and extensive intestinal resection for necrosis of the intestine. Although we planned to perform TEVAR following establishment of an internal endoconduit (IEC) of the common and external iliac arteries, the stent graft sheath did not pass IEC. We resolved the issue of the unfavorable access route with extravascular deployment of a stent graft following establishment of IEC (so-called extravascular endoconduit technique)

Preceding Coil Embolization for Internal Iliac Artery Aneurysm before Open Repair

Introduction: In the era of endovascular repair, open repair for abdominal aortic aneurysm (AAA) is still needed in the patients who had anatomical difficulties with the endovascular repair. Open repair for internal iliac artery aneurysm (IIAA) is a challenge because of the deep operating field, which is associated with high morbidity. Therefore, we performed preceding coil embolization for IIAA before open repair to control the bleeding from gluteal arteries. Materials and Methods: The present study is a retrospective case series study. Ten patients underwent preceding coil embolization for IIAA before open repair between January 2010 and August 2015. Three patients had two-stage coil embolization for bilateral IIAA. Six patients also had infrarenal AAAs. After preceding coil embolization, open repair consisting of vascular graft replacement with aneurysmectomy and closure of IIAA was undertaken. Results: The mean age was 72.5 ± 10.7 years. There were nine men and one woman. Operative time and intraoperative bleeding were 270 ± 50 min and 817 ± 671 mL, respectively. There was no postoperative mortality. Three patients developed morbidity, which consisted of paralytic ileus, pneumonia, and shower embolization caused by shaggy aorta. No recurrent IIAA, buttock claudication, and intestinal ischemia after the open repair were observed. Conclusion: Preceding coil embolization for IIAA before open repair may be an effective procedure to control the bleeding from gluteal arteries and prevent recurrent IIAA

Early cusp tear of the second-generation Trifecta valve with Glide Technology

Abstract We herein report a case of early cusp tear of the second-generation Trifecta valve with Glide Technology. A 69-year-old woman underwent aortic valve replacement with a Trifecta valve with Glide Technology and partial arch replacement for severe aortic valve stenosis caused by a bicuspid valve and ascending aortic and aortic arch aneurysms 2 years previously. During follow-up, she suddenly developed dyspnoea and a heart murmur. Echocardiography revealed severe aortic valve regurgitation caused by structural valve deterioration. We performed re-aortic valve replacement with a mechanical valve through re-median sternotomy. Intraoperative examination revealed a bottom tear of the left coronary cusp without infection or pannus formation.</jats:p

Modified Miniskirt Bentall with an Annular Pericardial Patch for Bentall's Endocarditis

Surgery for Bentall's endocarditis poses challenges because the infection spreads to the aortic valve annulus, leading to an annular abscess that necessitates reconstruction. We present a straightforward miniskirt Bentall procedure using an annular pericardial patch to treat Bentall's endocarditis with an annular abscess. After removing the former composite graft and debriding the aortic root and annulus, we created a miniskirt-composite graft using a mechanical or bioprosthetic valve, a straight or Valsalva graft, and an annular bovine pericardial patch with a valve prosthetic sizer. The miniskirt-composite graft, along with the underlying annular pericardial patch, was implanted using a double-layered suture technique