Direct operations for the management of life-threatening ischemic ventricular tachycardia

Between June 1978 and 1986, 93 consecutive patients underwent electrophysiologically guided operations for life-threatening recurrent sustained ventricular tachycardia mostly associated with other surgical procedures, such as left ventricular resection (aneurysmectomy) and coronary artery bypass grafting. Data: Eighty-seven percent of the surviving patients were free of spontaneous ventricular tachycardia return or sudden death 1 year after the operation and 77% at 5 years. The instantaneous risk of ventricular tachycardia return was highest immediately after operation, declined rapidly, and by 2 weeks postoperatively had merged with the constant hazard phase, which persisted as long as the patients were observed. Endocardial resection, rather than encircling endocardial myotomy, increased the risk of spontaneous ventricular tachycardia return/sudden death. Survival rates, including hospital deaths, were 95% at 30 days, 89% at 1 year, and 70% at 5 years after operation. The most prevalent mode of death was heart failure. The absence of anterolateral left ventricular aneurysms and the use of more extended encircling incisional techniques for ventricular tachycardia ablation increased the risk of early and late death. Survival was particularly poor in that subset of patients in whom recurrent sustained ventricular tachycardia returned after operation; the most prevalent mode of death in this group was also progressive left ventricular failure. Inferences: (1) Complete and partial encircling endocardial myotomy incisions are the most effective surgical techniques for malignant ventricular tachycardia ablation. (2) Because of their adverse effects on left ventricular structure and function, the arrhythmogenic tissues have to be localized as precisely as possible, and the encompassing incisions should be kept as limited as possible. (3) The late return of ventricular tachycardia may be more related to a progressive ischemic left ventricular cardiomyopathy than to an inadequate operation.     

OFAGE banding patterns of different yeast genera and of intergeneric hybrids

Electrophoretic karyotypes of yeasts belonging to the species Saccharomyces cerevisiae, Kluyveromyces marxianus and Candida macedoniensis were established by means of OFAGE. Hybrids between S. cerevisiae and K. marxianus as well as between K. marxianus and C. macedoniensis were analyzed by comparing their OFAGE-banding-pattern with the parental banding-patterns. Thus, evidence for exchanges of intact chromosomes and for chromosomal rearrangements could be gained on a molecular level.     

Corticosteroid treatment exacerbates nephrotic syndrome in a zebrafish model of magi2a knockout

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Retrograde transpedal stenting of the tibioperoneal trunk in critical limb ischemia

Management of critical limb ischemia (CLI) requires a combined treatment approach: optimal medical therapy and revascularization procedures are both essential for favorable outcome. With the development of endovascular interventions these new modalities took the primary role in limb revascularization, especially in CLI patients, where the culprit lesion is often located below the knee (BTK) level, making the surgical procedure unfeasible. In our present case report, we demonstrate a successful percutaneous recanalization of a surgically non‐treatable tibioperoneal trunk occlusion. The procedure was performed with dual access from anterograde and retrograde transpedal approach, and modified “V stenting” technique was used. We describe feasibility of bail out stenting using retrograde posterior tibial artery access after failed retrograde guidewire externalization. Our report discusses the feasibility, safety, and efficacy of the retrograde approach applying 4F compatible devices. © 2012 Wiley Periodicals, Inc.     

Total Endovascular Debranching of the Aortic Arch

Background

Significant morbidity and mortality are related to conventional aortic replacement surgery. Endovascular debranching techniques, fenestrated or branched endografts are time consuming and costly.

Objective

We alternatively propose to use endovascular approach with parallel grafts for debranching of aortic arch.

Methods

Under general anesthesia, 12 F sheaths were inserted in the femoral, axillary and common carotid arteries for vascular accesses. ViaBahn grafts 10 – 15 cm in length were placed into the aortic arch from right common carotid, left common carotid and left axillary arteries, until the tip of each graft reached into the ascending aorta. Through one femoral artery, the aortic stent –graft was positioned and delivered. Soon after, the parallel grafts were sequentially delivered. Self-spanding Wallstents^R were used for parallel grafts reinforcement. Ballooning was routinely used for parallel grafts and rarely for aortic graft.

Results

This technique was used in 2 cases. The first one was a lady with 72 years old, with an aortic retrograde dissection from left subclavian artery and involving remaining arch branches. Through right common carotid artery a stent-graft was placed in the ascending aorta and through the left common carotid artery a ViaBahn was inserted parallel to the former. A thoracic endograft then covered all the aortic arch dissection extending into the ascending aorta close to the sinu –tubular junction. The second case was a 82 year old male patient with a 7 cm aortic arch aneurysm. Through both common carotid arteries ViaBahn grafts were introduced and positioned into the ascending aorta. Soon after, the deployment of the thoracic stent graft covered all parallel grafts of the aortic arch, excluding the aneurysm. Both cases did not have neurologic or cardiac complications and were discharged 10 days after the procedure.

Conclusions

This technique may be a good minimal invasive off-the-shelf technical option for aortic arch ‘‘debranching’’. More data and further improvements are required before this promising technique can be widely advocated.     

Totally laparoscopic explantation of migrated stent graft after endovascular aneurysm repair: a report of two cases

This report describes the removal of two migrated stent grafts and the repair of abdominal aortic aneurysms by laparoscopic technique. In these two cases, endovascular treatment was not indicated because of device migration into the aneurysm and the presence of thrombus within the endografts. Operative times were 245 and 230 minutes, with aortic clamp times of 95 and 66 minutes. The patients were extubated immediately after the procedure, resumed a normal diet on postoperative day 2, and were discharged home on postoperative days 5 and 6. We believe these are the first reported cases of laparoscopic explantation of migrated aortic stent grafts in the literature.     

Laparoskopische Aortenchirurgie

The following article describes our technique and results with total laparoscopic aortic aneurysm repair. A distinction must be made between laparoscopic-assisted procedures requiring a mini-incision to perform an anastomosis and total laparoscopic operations where the whole procedure is performed laparoscopically. In addition to aorto-femoral or ileo-femoral bypass procedures, total laparoscopic techniques can be used to perform abdominal aortic aneurysm resections. A transperitoneal left retrorenal access is preferred in most cases. Special laparoscopic clamps, often in combination with balloon catheters are used to occlude the aorta and if necessary the renal arteries. Exactly the same techniques as used in open surgery are transferred to a laparoscopic setting. Either a tube graft repair or a bifurcated graft anastomosed with the iliac bifurcation or the femoral artery is performed to exclude the aneurysm. Laparoscopic techniques can also be used to treat patients with type II endoleakage after EVAR or cases with endotension. Lumbar arteries or the IMA are clipped and if necessary downsizing of the aneurysm can be accomplished by opening the sac of the AAA, evacuating the thrombus material and stitching lumbar arteries from the inside. More recently laparoscopic techniques have been used to reduce the access trauma in debranching procedures. The learning curve of total laparoscopic aortic procedures is still steep, but new instruments, staplers or robotic devices will probably shorten this learning curve in the future. In an increasing number of European countries laparoscopic aortic surgery is becoming a third way to perform aortic repair. In contrast to EVAR it can offer to aneurysm patients the same definitive outcome and long lasting results as open surgery.