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How a prosthesis in aortic valve replacement is chosen

Keywords aneurysms of descending aorta, surgery. intraluminal prosthesis.

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Surgical therapy of prosthetic infections of the thoracic aorta

Findings
Fluid around the aortic prosthesis is found. The aortic wall shows significant enhancement and oedematous fluid in the surrounding fat, as a sign of infection. The patient underwent nephrectomy on the left side.

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AB - The prosthetic graft infection of the thoracic aorta is a dreaded complication and it is associated with a high mortality rate. There is not substantial agreement in literature about how to manage a vascular graft infection, except for local anti-septic irrigation with a systemic antibiotic therapy. The main point of discussion is if it is mandatory to remove or not the infected thoracic aorta prosthesis: some authors prefer to eliminate all the thoracic aortic prostheses which may be infected, while others propose graft removal only when the sutures lines are involved. In this paper we report our experience on the conservative management of infected thoracic aorta prostheses using a local antiseptic irrigation, a perigraft debridement and leaving the original graft "in situ" when there is evidence of graft damage expecially or involvement of the sutures lines. This approach has been performed in three patients: two had an infected aortic arch prosthesis, while one had a descending thoracic aorta prosthesis infection.

not the infected thoracic aorta prosthesis: ..

QuestionCT Angiography of the abdominal aorta was performed to rule out an intraabdominal focus or prosthesis infection.

ABSTRACT
Aneurysms of descending aorta still cause great morbidity and mortality even in modern cardiac surgery days. In this paper, we describe the use of a recente technique which consists in the insertion of an intraluminal Dacron prosthesis, sutured only in its proximal end, just after the left subclavian artery. The prosthesis goes beyoud the aneurysm area and stays free in its distal aortic segment (elephant trunk). The operation is performed with bypass and profound hypothermia at 19ºC with circulatory arrest for just enough time to insert the prosthesis and make the proximal suture. Since May 1988 eight patients underwent this kind of surgery: six cases of acute type B dissection and two cases of saccular aneurysms. The procedure is very simple and fast and the post-operative results obtained make clear that our experience should go on. We recommend this procedure as a tactical alternative, specially for type B dissections.

N2 - The prosthetic graft infection of the thoracic aorta is a dreaded complication and it is associated with a high mortality rate. There is not substantial agreement in literature about how to manage a vascular graft infection, except for local anti-septic irrigation with a systemic antibiotic therapy. The main point of discussion is if it is mandatory to remove or not the infected thoracic aorta prosthesis: some authors prefer to eliminate all the thoracic aortic prostheses which may be infected, while others propose graft removal only when the sutures lines are involved. In this paper we report our experience on the conservative management of infected thoracic aorta prostheses using a local antiseptic irrigation, a perigraft debridement and leaving the original graft "in situ" when there is evidence of graft damage expecially or involvement of the sutures lines. This approach has been performed in three patients: two had an infected aortic arch prosthesis, while one had a descending thoracic aorta prosthesis infection.

Recognition of an infected endoluminal aortic prosthesis ..

21/12/2011 · Next generation surgical aortic biological prostheses : ..

AB - The sutureless intraluminal prosthesis was used in 22 patients with acute dissection of the ascending aorta (type A) between May, 1982, and September, 1985. The patients ranged from 26 to 77 years old (mean, 58 years). Diagnosis was established by aortogram in 18 patients and by two-dimensional echocardiogram in 4 patients. Additional procedures included resuspension of the aortic valve in 7 patients, single coronary artery bypass in 1 patient, and cesarean delivery of a term pregnancy in 1 patient. Nineteen patients survived operation and were discharged from the hospital (86% early survival). Three patients died, 2 of hemorrhage and myocardial failure in the operating room, and 1 of sepsis following a prolonged hospitalization. Early postoperative complications included one instance of renal failure, one perioperative myocardial infarction, and one cerebrovascular accident (CVA). There were no reoperations for bleeding. Follow-up was obtained on 17 patients (90%) and ranged from 10 to 50 months (mean, 30 months). Thirteen of the survivors are well, 11 have returned to work, 2 have had a CVA, and 1 has a descending thoracic aneurysm. We conclude that the intraluminal graft is a good option for repair of acute type A dissections because it (1) reestablishes central aortic flow, (2) obliterates the false channel entry site, (3) minimizes operative blood loss, and (4) permits expeditious repair with minimal trauma to friable tissues.

The prosthetic graft infection of the thoracic aorta is a dreaded complication and it is associated with a high mortality rate. There is not substantial agreement in literature about how to manage a vascular graft infection, except for local anti-septic irrigation with a systemic antibiotic therapy. The main point of discussion is if it is mandatory to remove or not the infected thoracic aorta prosthesis: some authors prefer to eliminate all the thoracic aortic prostheses which may be infected, while others propose graft removal only when the sutures lines are involved. In this paper we report our experience on the conservative management of infected thoracic aorta prostheses using a local antiseptic irrigation, a perigraft debridement and leaving the original graft "in situ" when there is evidence of graft damage expecially or involvement of the sutures lines. This approach has been performed in three patients: two had an infected aortic arch prosthesis, while one had a descending thoracic aorta prosthesis infection.

A misinterpreted case of aorta prosthesis endocarditis
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Arquivos Brasileiros de Cardiologia ..

The management and treatment of an infected aortic aneurysm is a tricky one and is usually done by graft excision and creation of an extra anatomic conduit. We present here a case of a 53 year old patient who underwent a prosthetic graft insertion for leaking thoracic aortic ulcer with esophageal compression. Post operatively, the thoracic wound got infected and he developed esophageal leak for which a de-functioning esophagectomy had to be done. Later, the patient had bleeding from thoracic cavity and developed cardiovascular collapse. He was managed successfully by creation of an extra anatomic conduit from ascending aorta to bilateral femoral arteries followed by excision of the original prosthetic graft.

suture approximating the cuff of the prosthesis to the native ..

N2 - The sutureless intraluminal prosthesis was used in 22 patients with acute dissection of the ascending aorta (type A) between May, 1982, and September, 1985. The patients ranged from 26 to 77 years old (mean, 58 years). Diagnosis was established by aortogram in 18 patients and by two-dimensional echocardiogram in 4 patients. Additional procedures included resuspension of the aortic valve in 7 patients, single coronary artery bypass in 1 patient, and cesarean delivery of a term pregnancy in 1 patient. Nineteen patients survived operation and were discharged from the hospital (86% early survival). Three patients died, 2 of hemorrhage and myocardial failure in the operating room, and 1 of sepsis following a prolonged hospitalization. Early postoperative complications included one instance of renal failure, one perioperative myocardial infarction, and one cerebrovascular accident (CVA). There were no reoperations for bleeding. Follow-up was obtained on 17 patients (90%) and ranged from 10 to 50 months (mean, 30 months). Thirteen of the survivors are well, 11 have returned to work, 2 have had a CVA, and 1 has a descending thoracic aneurysm. We conclude that the intraluminal graft is a good option for repair of acute type A dissections because it (1) reestablishes central aortic flow, (2) obliterates the false channel entry site, (3) minimizes operative blood loss, and (4) permits expeditious repair with minimal trauma to friable tissues.

Endovascular Repair of Aortic Aneurysms - Medical …

The sutureless intraluminal prosthesis was used in 22 patients with acute dissection of the ascending aorta (type A) between May, 1982, and September, 1985. The patients ranged from 26 to 77 years old (mean, 58 years). Diagnosis was established by aortogram in 18 patients and by two-dimensional echocardiogram in 4 patients. Additional procedures included resuspension of the aortic valve in 7 patients, single coronary artery bypass in 1 patient, and cesarean delivery of a term pregnancy in 1 patient. Nineteen patients survived operation and were discharged from the hospital (86% early survival). Three patients died, 2 of hemorrhage and myocardial failure in the operating room, and 1 of sepsis following a prolonged hospitalization. Early postoperative complications included one instance of renal failure, one perioperative myocardial infarction, and one cerebrovascular accident (CVA). There were no reoperations for bleeding. Follow-up was obtained on 17 patients (90%) and ranged from 10 to 50 months (mean, 30 months). Thirteen of the survivors are well, 11 have returned to work, 2 have had a CVA, and 1 has a descending thoracic aneurysm. We conclude that the intraluminal graft is a good option for repair of acute type A dissections because it (1) reestablishes central aortic flow, (2) obliterates the false channel entry site, (3) minimizes operative blood loss, and (4) permits expeditious repair with minimal trauma to friable tissues.

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