Kommerell's diverticulum (KD) is a rare congenital vascular abnormality due to the formation of an abnormal aortic arch, most commonly associated with dilatation at the proximal part of the aberrant subclavian artery. This article describes an option of surgical treatment in a patient with KD. The proposed new technique of aortic arch surgical reconstruction with a stent-graft placement in the descending aorta reduces CPB time, aortic clamp and circulatory arrest time.
1ФГБУ «Новосибирский НИИ патологии кровообращения им. акад. Е. Н. Мешалкина» МЗ РФ, г. Новосибирск 2 ГБУЗ «НИИ -краевая клиническая больница № 1 им. проф. С. В. Очаповского», г. Краснодар 3 ФГБУ «Федеральный центр сердечно-сосудистой хирургии», г. Пермь В обзоре продолжено рассмотрение аспектов управления основными физиологическими параметрами во время искусственного крово-обращения у взрослых пациентов с позиции доказательной медицины, начатое в предыдущем номере журнала. Данная часть посвящена управлению температурой, доставкой кислорода и пульсацией. Делается заключение, что в настоящее время большинство рекомендаций по проведению искусственного кровообращения не имеют серьезной доказательной базы. Для достижения наилучших клинических результатов предложено отслеживать публикуемые данные и соотносить их с собственным опытом с учетом соотношения польза/риск. Показано, что в основе большинства осложнений, связанных с искусственным кровообращением, лежат разные причины, и это диктует необходимость мультидисциплинарного подхода к их предотвращению. This review continues to investigate the management aspects of main physiological parameters during artificial blood circulation in the adult patients from the position of the evidence based medicine, and the first part of this review was published in the previous issue. This part is devoted to management of temperature, oxygen delivery and pulsation. The authors conclude that currently the majority of recommendations for artificial blood circulation are not based on the relevant evidences. In order to achieve best clinical results it has been offered to review the published data and relate them with the personal experience evaluating benefits and risks. It has been shown that the majority of complications related to artificial blood circulation have various causes and it demands the multi-disciplinary approach to their prevention.
<p><strong>Background.</strong> Currently, aortic valve stenosis is the most common disease of the native valve, which affects 5% of the elderly population. In symptomatic patients, aortic valve replacement is the ‘gold standard’. For patients aged ≥65 years, the use of biological prostheses is recommended. The Ozaki operation is an alternative to bioprostheses.</p><p><strong>Aim.</strong> The aim of this study was to evaluate the immediate and 3-year results of Ozaki surgery in patients aged ≥65 years.</p><p><strong>Methods.</strong> This was a prospective multicentre study conducted on 107 patients aged ≥65 years, who underwent the Ozaki procedure at three centres during 2016–2019. There were 46 (43%) men. The median age of the patients was 69 [67–74] years. Severe aortic stenosis was the major cause of aortic valve dysfunction (106 patients [99.1%]). Chronic heart failure III–IV functional class according to NYHA was diagnosed in 47 (43.9%) patients. The following complications were also registered: atrial fibrillation in 30 (28%) patients, a history of diabetes mellitus in 16 (15%) patients, chronic obstructive pulmonary disease in 14 (13.1%) patients and coronary artery disease in 42 (39.2%) patients. Bicuspid aortic valve was detected in 36 (34.6%) patients. There were 72 (67.2%) patients with a small annulus (≤21 mm) and 59 (55.14%) patients with a left ventricular ejection fraction of 64%. The median follow-up period was 23 [18–33] months. This study included all patients who underwent Ozaki surgery from 2016 to 2019.</p><p><strong>Results.</strong> No patient had any conversions. A total of 45 (42.1%) patients underwent combined interventions. The operation duration was 240 [214–300] min, cardiopulmonary bypass duration was 104 [93–120] min and aortic cross-clamp duration was 82 [72–95] min. The rate of hospital mortality was 1.9%, and the incidence rates of acute renal failure requiring haemodialysis, stroke, pacemaker implantation, sepsis and reoperation for bleeding were 1.9%, 0.9%, 1.9%, 0.9% and 0.9%, respectively. The hospitalisation duration was 14 [11–16] days. The gradients of peak and mean pressure on the aortic valve after surgery were 9 [7–13] and 4 [3–6] mmHg, respectively, and the effective valve opening area was 2.6 [2.3–2.9] cm<sup>2</sup>. None of the patients had moderate and severe aortic regurgitation. The 3-year overall survival and freedom from reoperation were 88.6% and 97%, respectively.</p><p><strong>Conclusion.</strong> The Ozaki operation in patients aged ≥65 years has good immediate results, with a hospital mortality rate of 1.9%, excellent haemodynamic parameters with an average pressure gradient across the aortic valve of 4 [3–6] mmHg and a valve opening area of 2.6 [2.3–2.9] cm<sup>2</sup>. The 3-year overall survival and freedom from reoperation were 88.6% and 97%, respectively. Further monitoring of these patients is required to evaluate long-term results, and there is also a need for randomised clinical trials comparing Ozaki operation with bioprostheses.</p><p>Received 4 February 2021. Revised 21 June 2021. Accepted 23 June 2021.</p><p><strong>Funding:</strong> The study did not have sponsorship.</p><p><strong>Conflict of interest:</strong> Authors declare no conflict of interest.</p><p><strong>Contribution of the authors<br /> </strong>Conception and study design: I.I. Chernov, R.N. Komarov, D.G. Tarasov, Yu.S. Sinelnikov, A.V. Marchenko, V.B. Arutyunayan, K.Yu. Zhigalov<br /> Data collection and analysis: B.K. Kadyraliev, A.M. Ismailbaev, B.M. Tlisov, D.A. Zorin, M.I. Tcheglov<br /> Statistical analysis: S.T. Enginoev<br /> Drafting the article: I.I. Chernov, S.T. Enginoev<br /> Critical revision of the article: I.I. Chernov, R.N. Komarov, D.G. Tarasov, Yu.S. Sinelnikov, A.V. Marchenko, V.B. Arutyunayan, K.Yu. Zhigalov<br /> Final approval of the version to be published: I.I. Chernov, S.T. Enginoev, R.N. Komarov, D.G. Tarasov, Y.S. Sinelnikov, A.V. Marchenko, V.B. Arutyunayan, B.K. Kadyraliev, A.M. Ismailbaev, B.M. Tlisov, D.A. Zorin, M.I. Tcheglov, K.Yu. Zhigalov</p>
<p>Surgical treatment of congenital heart defects with the obstruction of the outflow tract of the right ventricle can be performed in several stages. The first stage of surgical correction is the creation of a systemic-pulmonary shunt, followed by radical correction. The main complications of systemic-pulmonary shunts are associated with the development of shunt thrombosis and hypervolemia of the pulmonary circulation. Currently, considering the importance of individual selection of a shunt for effective functioning, the main scientific search is aimed at creating optimal methods that consider all the hemodynamic features of a particular patient. Recently, the direction of mathematical modelling and biomechanical analysis in medicine has been actively developing, facilitating the objective evaluation of the accumulated clinical experience and is one of the main tools in evidence-based medicine. The use of computational fluid dynamics methods for modified Blalock–Taussig shunt analysis allows us evaluate the hemodynamic parameters for various configurations of shunts and anastomosis angles and improve the understanding of pathophysiological processes in the cardiovascular system before or after an application of the modified Blalock–Taussig shunt. Here, we provide an overview of the work related to the use of modelling for the calculation of the currents in the aorta–shunt–pulmonary artery system. It is noteworthy that most studies consider the personalised characteristics of the patients and are therefore highly likely to be used in clinical practice. The main hemodynamic parameters that are analysed with the computer calculations are described. Part of the work is devoted to the stages of computer modelling and the limitations in the implementation of these stages. We believe that this manuscript will be of interest to specialists in cardiovascular surgery and to the several scholars working in areas related to the use of digital technologies in medicine, mathematical modelling in medicine and biomechanics.</p><p>Received 30 January 2020. Revised 25 May 2020. Accepted 9 June 2020.</p><p><strong>Conflict of interest:</strong> Authors declare no conflict of interest.</p><p><strong>Funding:</strong> The work is supported by the program for the development of the Scientific and Educational Mathematical Center of the Volga Federal District (No. 075-02-2020-1478) and a grant for the development of the scientific school of the Perm Region “Computer biomechanics and digital technologies in biomedicine”.</p><p><strong>Author contributions</strong><br />Conception and design: Yu.S. Sinelnikov, V.B. Arutunyan, A.A. Porodikov, A.N. Biyanov, V.S. Tuktamyshev, M.I. Shmurak,<br />A.R. Khairulin<br />Drafting the article: A.A. Porodikov, A.N. Biyanov, A.G. Kuchumov<br />Critical revision of the article: A.N. Biyanov, A.G. Kuchumov<br />Final approval of the version to be published: Yu.S. Sinelnikov, V.B. Arutunyan, A.A. Porodikov, A.N. Biyanov, V.S. Tuktamyshev, M.I. Shmurak, A.R. Khairulin, A.G. Kuchumov</p>
Cardiosurgical stress initiates endothelial injury of the colliquation necrosis type (without activating coagulation necrosis) in coronary capillaries of infants aged under 1 year. The dark cells exhibited high tolerance to operation stress in the presence of labile ultrastructural response of endothelial cells of the main and light types. The percentage of dark cells does not change during surgical intervention, which is a sign predicting a favorable course of the postoperative period.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.