Early mechanical failures of the Hancock pericardial xenograft

From August 1981 to July 1984, a total of 97 Hancock pericardial xenografts were implanted in 84 patients, whose ages ranged from 13 to 75 years (mean 55.7 +/- 13). Mitral value replacement was performed in 17, aortic valve replacement in 54, and mitral-aortic valve replacement in 13. Operative survivors were reevaluated from July to September 1985. Cumulative duration of follow-up is 167 patient-years (range 0.5 to 4.1 years), and follow-up is 99% complete. The overall late mortality (at 4 years) is 3.6% +/- 1.4% per patient year, and the actuarial survival rate is 95.4% +/- 3% for aortic valve replacement, 74.7% +/- 16.5% for mitral valve replacement, and 67.1% +/- 20.7% for mitral-aortic valve replacement. One patient sustained a thromboembolic event after mitral valve replacement, but no such complications occurred after aortic or mitral-aortic valve replacement. Actuarial freedom from embolism at 4 years is 100% for aortic and mitral-aortic valve replacement and 93.3% +/- 6.4% for mitral valve replacement. Reoperation for Hancock pericardial xenograft dysfunction was performed in seven patients (five aortic and two mitral-aortic). In the aortic valve replacement group the causes were endocarditis in one, paravalvular leak in one, and primary tissue failure in three; all survived reoperation. The two patients with mitral-aortic valve replacement required reoperation because of primary tissue failure of both Hancock pericardial xenografts, and one died. All values explanted because of primary tissue failure showed commissural tears causing severe prosthetic regurgitation. Calcium deposits were severe in one and mild but unrelated to the cusp rupture in another. Collagen disarray was seen only at the site of the tears, whereas the collagen structure was well preserved in the intact parts of the cusps. Four patients with aortic valve replacement and one with mitral valve replacement show evidence of Hancock pericardial xenograft failure and are awaiting reoperation. The actuarial freedom from primary tissue failure at 4 years is 74.3% +/- 9.8% for aortic and 78.9% +/- 13.2% for mitral Hancock pericardial xenografts. At medium-term follow-up, the Hancock pericardial xenograft has shown poor durability and an extremely high rate of early mechanical failure, especially in the aortic position. These observations suggest the need for a close follow-up of Hancock pericardial xenograft recipients and possibly elective reoperation in asymptomatic patients with clinical evidence of prosthetic failure. These results have led us to discontinue the clinical use of this pericardial xenograft.     

"Less stented" bovine pericardial xenograft: a new concept

Abstract:  The in vitro hemodynamic behavior of a bovine pericardium xenograft with discontinuity of the annular support, named the "Less Stented" bovine pericardial xenograft, was analyzed. A "Less Stented" bovine pericardial xenograft consisting of a glutaraldehyde-treated bovine pericardium prosthesis manufactured in Braile Biomédica Ltd, São José do Rio Preto, São Paulo, Brazil, was used according to the same protocols of the stented bioprosthesis manufacturer. Bovine pericardial xenografts were tested in a pulse simulator and analyzed in a cardiac simulator, with respect to the transvalvular gradient, regurgitant fraction and leakage volume, discharge coefficient, performance, and efficiency index. Analyses were performed by Pearson's correlation test and simple linear regression. The transvalvular gradients ranged between 6.37 and 11.62 mm Hg with a mean flow between 4.39 and 7.96 L/min, giving a good correlation (0.8291) on the regression curve with an increase in flow. The regurgitant fraction ranged between 10.95 and 17.94% and leakage volume between 4.49 and 7.87%. The discharge coefficient, performance, and efficiency index showed favorable behavior with the flow increase, with good correlation coefficient (0.9385, 0.9332, and 0.9024, respectively). The initial results of the "Less Stented" bovine pericardial xenograft size 25 analyses demonstrated a satisfactory in vitro performance. Evaluations of the hemodynamic performance of small size "Less Stented" bovine pericardial xenograft should be made to clarify the biological behavior of this new xenograft.     

The influence of age on the durability of Carpentier-Edwards biological valves : Thirteen years follow-up

Two hundred and ninety-nine patients received 325 Carpentier-Edwards biological valves from April 1976 to April 1982. Valves were placed in the following positions: 150 aortic (AVR), 120 mitral (MVR), 26 multiple (MR), 2 pulmonary (PR) and 1 tricuspid (TR). The mean age was 54.7 years. The total follow-up time was 2545 patient-years. Patients were divided into different age groups: < 40, 40–49, 50–59, 60–69 and > 70 years and were followed-up for reoperations and tissue failure. Ninety-three operations were performed in 91 patients (30.5%) for valve related dysfunctions. The main cause of reoperation was primary tissue failure (85%). The respective incidence and risk of reoperation in the different age groups were 51.5% and 5%, 41.5% and 4%, 32% and 3%, 18% and 2.5%, and 0% for > 70 years of age. The risk of reoperation decreased significantly with increasing age (P < 0.05). The respective incidence and risk of tissue failure in the age groups were 43.8% and 4.1%, 35% and 4%, 27.3% and 3.2%, and 17.2%, 2.4% and 0%. The freedom from reoperation and tissue failure was significantly higher in the older patient (> 60 years) compared to the younger patients (< 60 years). The commonest cause of failure in young patients was calcification, while in older patients it was cusp rupture. Comparing aortic and mitral bioprostheses in the different age groups showed no difference between these valves in patients < 50 years of age. In patients > 50 years of age, there was a significantly higher incidence of reoperation (P < 0.05) and risk (P < 0.05) in patients with mitral bioprostheses compared to those with bioprostheses.     

Right hemi-reconstruction of the left atrium using two equine pericardial patches for recurrent malignant fibrous histiocytoma: Report of a case

We report a case of recurrent malignant fibrous histiocytoma (MFH) in the left atrium, treated by removal of the tumor and the right half of the left atrium, which was reconstructed with two equine pericardial patches. Postoperative echocardiography showed patent right pulmonary veins and a properly shaped left atrium. The patient survived for 3 years after the operation with no cardiac symptoms.     

Encapsulated pericardial fat necrosis treated by video-assisted thoracic surgery: Report of a case

A 55-year-old moderately obese man who was admitted to a local hospital following a traffic accident reported having experienced an episode of sharp and sudden pleuritic pain in the left anterior lower chest 2 days earlier. A computed tomographic scan on admission demonstrated a nonhomogeneous mass in the anterior left side of the chest, abutting the left cardiac margin, and a left-sided pleural effusion. As a mediastinal tumor was suspected, he was referred to our hospital for investigation and treatment. An exploratory thoracotomy was performed by video-assisted thoracic surgery (VATS) about 3 weeks later, which revealed a firm, yellowish mass on the oral side of the pericardial fat pad, adhering to the anterior chest wall. The mass was easily removed. The resected specimen consisted of a lobulated fragment of adipose tissue measuring 5.0 × 3.5 × 2.0 cm, and the final pathologic diagnosis was pericardial fat necrosis. The patient had an uneventful postoperative recovery and has remained free of symptoms for 10 months since his operation. Pericardial fat necrosis remains a rare clinical entity. Surgical excision by VATS achieves symptomatic cure and probably continues to be the treatment of choice because of the need to exclude a neoplasm in the differential diagnosis. Received: March 15, 1999 / Accepted: March 24, 2000     

A case of intrapericardial diaphragmatic hernia with a massive pericardial effusion: fetal diagnosis and therapy

Intrapericardial diaphragmatic hernia is a very rare phenotype of neonatal diaphragmatic hernia which is thought to be caused by the developmental failure of the septum transversum. There have been only 10 cases reported since 1980, and among them, only 2 cases were diagnosed in fetal life. We herein report a new case that was diagnosed in fetal life, and pericardiocentesis was performed at 27 weeks of gestation. This is the first case to undergo a fetal interventional therapy. After birth, the patient successfully underwent closure of the hernia, despite severe pulmonary hypoplasia.     

Platelet-rich plasma for the treatment of patellar tendinopathy: clinical and imaging findings at medium-term follow-up

Purpose

The purpose of this study was to evaluate the efficacy of multiple platelet-rich plasma (PRP) injections on the healing of chronic refractory patellar tendinopathy, and report the quality and duration of the clinical improvement up to a medium-term follow-up.

Methods

Forty-three patients (mean age, 30.6 years; mean BMI, 24.7; 42 men, one woman) affected by chronic patellar proximal tendinopathy were enrolled in this trial. Eleven patients were affected by bilateral tendinopathy. They underwent three ultrasound guided intra-tendinous injections of five millilitres PRP, two weeks apart from each other. Patients were prospectively evaluated initially, then after two, six, and up to mean 48.6 ± 8.1 months of follow-up (minimum evaluation at 36 months). The following evaluation tools were used: Blanzina, VISA-P, EQ-VAS for general health, and Tegner scores. Patients’ overall satisfaction and time to return to sport were also reported.

Results

Good and stable results were documented over time, with the VISA-P score increasing from 44.1 ± 15.6 at baseline to 61.4 ± 22.2 at two months, 76.6 ± 25.4 at six months, and 84.3 ± 21.6 at four years’ follow-up. The same trend was confirmed by the other scores used, and 80 % of the patients were satisfied and returned to previous sports activities. Significantly poorer results were obtained in patients with a longer history of symptoms, and poor results were also observed in bilateral lesions. No correlation between ultrasonographic and clinical findings could be found.

Conclusions

Multiple injections of PRP provided a good clinical outcome for the treatment of chronic recalcitrant patellar tendinopathy with stable results up to medium-term follow-up. Patients affected by bilateral pathology and presenting a long history of pain obtained significantly poorer results.     

不同术式精索静脉高位结扎术后睾丸鞘膜积液发病率的比较

目的 探讨男性患者采用不同术式行精索静脉高位结扎术后睾丸鞘膜积液的发病率,发病时间,及其与手术术式的相关性.方法 总结165例男性精索静脉曲张患者不同术式的182次精索静脉高位结扎术,回顾性分析不同术式睾丸鞘膜积液的发病率.结果 患者术后出现了25例次的鞘膜积液.Poloma术后鞘膜积液的发生率为21.2%,Ivanissevich术后鞘膜积液的发生率为13.2%,腹腔镜精索内静脉高位集束结扎的患者术后鞘膜积液的发生率为20.7%,而高位分离结扎的患者术后鞘膜积液的发生率为8.O%;术后6个月内出现鞘膜积液并不常见,大多数出现鞘膜积液的患者都是在手术12个月以后,甚至手术2年以后.结论 术中保留淋巴管对于预防术后睾丸鞘膜积液的发生具有重要意义.     

Ten-year echocardiographic and clinical follow-up of aortic Carpentier-Edwards pericardial and supraannular prosthesis: a case-match study

BACKGROUND: There are little comparative data on Carpentier-Edwards supraannular and pericardial second-generation bioprostheses. The aim of this work was to compare their hemodynamic and clinical outcomes in patients with aortic stenosis. METHODS: We conducted a retrospective study including 150 patients operated on for aortic stenosis between 1989 and 1993. Patients undergoing aortic valve replacement with either a Carpentier-Edwards supraannular or pericardial prosthesis were matched for sex (49% male), age (72 +/- 8 years), body surface area, valve size, associated procedures, and left ventricular ejection fraction. RESULTS: Mean follow-up was 6.5 +/- 3.3 years, giving a total follow-up of 983 patient-years. Thirty-day mortality and 10-year actuarial survival were, respectively, 8% and 51% in the supraannular group and 6.7% and 43.4% in the pericardial group. At 10 years, freedom from thromboembolism, structural failure, and all valve-related events were, respectively, 88.7%, 88.9%, and 68.7% in the supraannular group and 85%, 100%, and 82.2% in the pericardial group. There were four (5.3%) structural failures, and four (5.3%) reoperations for degeneration (n = 3) and endocarditis (n = 1) in the supraannular group. Freedom from structural dysfunction or reoperation was 87.3% in the supraannular group and 100% (p < 0.05) in the pericardial group. Echocardiographic review of 62 of 76 survivors (81.5%) demonstrated a trend toward a better hemodynamic profile of pericardial valves at the end of follow-up. CONCLUSIONS: Ten years after aortic valve replacement for aortic stenosis, Carpentier-Edwards pericardial prostheses give comparable and probably better results than Carpentier-Edwards supraannular prostheses.     

The incidence of gastroesophageal reflux after transthoracic esophagocardio-myotomy without fundoplication: a long term follow-up.

OBJECTIVE: Evaluation of the long term results of Heller's myotomy performed over a lateral thoracotomy without additional fundoplication. Methods: Forty patients (17 males, 23 females; mean age 43.2 years; range: 14-63 years) were operated between 1985 and 2000. Preoperative evaluation included clinical scoring of symptoms, esophagogram, endoscopy, manometry and 24-h ph-metry. At the follow-up investigation, the preoperative evaluation was repeated in all patients, adding a histological workup of the distal esophageal mucosa. The mean duration of follow-up after surgery was 10.3 years, ranging from 3-16 years. RESULTS: The clinical scores improved significantly: Excellent relief from dysphagia was present in 86%, little or no regurgitation was found in 79%, little or no retrosternal spasms were reported by 72% of the patients. Esophagogram showed an overall esophageal dilatation in all patients but no significant obstruction at the esophagogastric junction. Endoscopically, 2.5% had candida-esophagitis, 5% showed signs of a GERD I, 92.5% had a macroscopically insuspect esophageal mucosa. Histologically, 53% showed a mild chronic inflammation. Manometry demonstrated distinct hypomotility of the esophagus in all cases, yet no elevated pressure of the lower sphincter; pH-metry showed moderate reflux in 46%. CONCLUSIONS: Transthoracic cardiomyotomy is a valid method for the treatment of achalasia, but it will not improve the esophageal motility, which slowly deterioriates in these cases. The patient's subjective assessment of the postoperative result was positive in the majority of cases. Although fundoplication was not done in any of these patients, none of them showed signs of clinically relevant reflux.     

The incidence of soft tissue sarcoma in Dakshina Kannada: study in a District Government Hospital

Background  

We present a retrospective study depicting the incidence and outcome of soft tissue sarcomas (STSs) in patients admitted in a District Government Hospital situated in coastal belt of Southern India for a period of four and a half years. The hospital is a district referral centre catering to rural and urban poor population of 1,900,000 people.     

Bovine pericardium versus porcine aortic valve: comparison of tissue biological properties as prosthetic valves

The choice of a bioprosthetic valve substitute remains controversial with the major concern being primary tissue failure after implantation. We compared biological properties of the two most frequently used bioprosthetic valve materials, bovine pericardium and porcine aortic valve, before and 90 days after subcutaneous implantation in rats. Before implantation, tissue collagen and water content were measured in nine pieces of bovine pericardium and porcine valves, each fixed in 0.625% glutaraldehyde; calcium, tissue collagen, and water content were measured in another nine pieces of the same tissues after 90 days' implantation. Bovine pericardium had higher collagen content than that of porcine valve (hydroxyproline, 7.98 +/- 0.05* vs. 4.56 +/- 0.02 micrograms/mg, dry weight) but lesser water content (72.16 +/- 3.22%* vs. 87.36 +/- 1.62%) before implantation (*p < 0.001, mean +/- SD, t test); after implantation, bovine pericardium still maintained higher collagen content (hydroxyproline, 4.89 +/- 0.04* vs. 2.61 +/- 0.06 micrograms/mg, dry weight) but contained the same amount of water (60.24 +/- 5.08% vs. 61.43 +/- 9.00%) and calcium (214.43 +/- 34.34 vs. 199.33 +/- 53.44 micrograms/mg, dry weight) (*p < 0.001, mean +/- SD, t test). We conclude that bovine pericardium has superior intrinsic biological properties for prosthetic valve manufacture. With proper integration of properties and design it will in some applications be superior to the porcine aortic valve.     

Management of early ankle osteoarthritis through anterior joint-preserving surgery: a retrospective evaluation at mid- to long-term follow-up

European Journal of Orthopaedic Surgery & Traumatology - Chronic anterior ankle pain is a recognized and straightforward characteristic of anterior impingement syndrome. This retrospective...     

The early results of high-flex total knee arthroplasty: a minimum of 2 years of follow-up

We retrospectively reviewed our first 25 cases of high-flex total knee arthroplasty (TKA) with an average follow-up of 28 months. The results were compared to a matched group of posterior stabilized (PS) TKA. There was no significant difference in Knee Society Scores between the 2 groups. The high-flex group had an averaged 138 degrees of knee flexion, which was significantly higher than the PS group (average, 126 degrees). Eighty percent of patients in high-flex group were able to squat, which was significantly higher than in PS group (32%). In patients with a small bone frame, occasionally, their bone stock of the posterior femoral condyle is inadequate for high-flex TKA. For the patients without special demands, the additional knee flexion from high-flex design made no significant difference on the results.