BackgroundWithin the trans-subclavian approach, procedural techniques can vary widely, and reported access generally refers to an infraclavicular axillary approach. We describe and report the use of a novel supraclavicular true subclavian approach for transcatheter aortic valve replacement (TAVR) exclusively for implantation of Sapien 3 valves.Case presentationWe report our first five consecutive patients undergoing TAVR with a Sapien 3 valve using a standardized subclavian approach at a single center. In-hospital and 30-day complications were reported. The use of this approach resulted in successful implantation in 100% of patients in a safe manner with 0% mortality, stroke, and vascular injury during hospitalization and at 30 day follow-up. The in-hospital pacemaker implantation rate was 20%. The average length of stay was 3 days.ConclusionsTAVR with Sapien implant can be safely performed with a standardized supraclavicular subclavian approach in patients with unfavorable femoral access.
The interrelationship of pregnancy with Crohn's disease is as nebulous as aetiology and pathogenesis of this inflammatory bowel disease. In the years 1964-1981 we have operated upon 342 patients with Crohn's disease. 47 women suffering from this disease became pregnant. Whereas pregnancy appears to have little influence on the course of Crohn's disease, the incidence of miscarriages appears to rise with increasing activity and extent of bowel involvement. Only in case of exacerbation or complications is medical or even surgical therapy indicated in the course of pregnancy. Abortion does not appear to influence the course of Crohn's disease favourably.
From 1964 to 1979 40 de-choledochoduodenostomies were performed: 15 for hepatocholedocholithiasis, 7 for shrinkage of the anastomosis, 8 for a blind loop syndrome and 12 for cholangitis. In 32 cases normal bile drainage through the papilla could be reestablished; in only one case a papillotomy was necessary. In all others a dilatation of the papilla alone was effective. Hepaticojejunostomy (Roux-en-Y) was performed in 7 cases. In one case of ascending papillomatosis of the choledochus a partial duodenopancreatectomy was necessary. No patient died postoperatively.
Zusammenfasstmg. 310 Patienten (79 % Manner, 14 70 Ausl~inder) mit Ulcera duodeni (71 70), Ulcera ventriculi (18 70) und kombinierten Ulcera (5,4 %) wurden von 1970 bis 1979 elektiv (n = 277) mad notfallm~il3ig (n = 33) von 27 Chirurgen opertiert; bis 1976 vorwiegend SPV + Pyloroplastik danach alleinige SPV, n = 172. Die Operationsletalit~it nach Weinberg betrug 0,3 70 (0 70 for elektive -und 1% fOr Notfalleingriffe). Die Gesamtletalit~it 2,2 70 (2 nach 277 elektiven mad 5 nach 33 Notfalleingriffen). Intraoperative Komplikationen (5mal Milz, 3mal Oesophagusl~ision) muBten in 2,9 70 der F~ille, postoperativ in 13 70 (19mal Pneumonie) hingenommen werden. Bei 91 70 gelang Verlaufskontrolle bis zu 10 Jahren nach der Operation. fiber leichte Dumpingsymptome klagten 12,270, iiber leichte Diarrhoen 1,3%. Gesicherte Rezidive fanden sich bei 22 Patienten = 8,1%. In der Gruppe der Patienten mit Ulcera ventriculi (n = 51 + 21) traten 5 Rezidive wiederum im Magen auf. Schliisselw6rter: Selektiv proximale Vagotomie -Ulcus duodeni -Ulcus ventriculi -Langzeitresultate.
Technische Grund~tze der vollsfiindigen proximal-selektiven Vagotomie (PSV)Summary. Based on anatomical conditions, results of clinical trials, and the significant influence of the intraoperative electrotest on postoperative secretion and recurrence rate after PGV, a reliable surgical technique should include: (1) extended dissection of the cardia and the fundus, (2) denudation of the oesophagus up to 6 cm, (3) skeletonization of the lesser curvature down to 6 cm from the pylorus, (4) an intra-operative electrotest and (5) in selected cases an anterior or circular myotomy of the oesophagus. Myotomy can only be justified by a persistingly positive electrotest.
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