Ossicular chain reconstruction in chronic otitis media: hearing results and analysis of prognostic factors

IntroductionThe goal of ossiculoplasty is to improve hearing and the success of this procedure depends on several factors.ObjectiveAnalyze the hearing results in patients with chronic otitis media undergoing ossicular chain reconstruction, as well as predictive factors for successful surgery.MethodsCharts of patients undergoing ossiculoplasty between 2006 and 2016 were reviewed. Sixty-eight patients were included, totaling 72 ears. The following data was analyzed: gender, age, smoking status, laterality, pathology, audiometric exams, type of surgery, previous surgery, characteristics of the middle ear, otorrhea and ossicular chain status. Patients were also classified according to two indices: middle ear risk index and ossiculoplasty outcome parameter staging. The results were evaluated by comparing the air-bone gap before and after surgery. The success of reconstruction was defined as air-bone gap ≤20 dB and the improvement of speech reception Thresholds, calculated through the mean frequencies 0.5, 1, 2 and 3 kHz.ResultsReconstruction success rate was 61%. The mean preoperative air bone gap was 34.63 dB and decreased to 17.26 dB after surgery. There was a correlation between low risk in middle ear risk index and ossiculoplasty outcome parameter staging indices with postoperative success. The most frequently eroded ossicle was the incus and the type of prosthesis most used was tragal cartilage. In the patients without incus, we achieved success in 74.2% of the surgeries. In the absence of the stapes, the success rate decreased to 63.3%. In the absence of the malleus, 85% of the patients had and air bone gap ≤20 dB.ConclusionWe achieved good audiometric outcomes in ossiculoplasty and the results are comparable to other centers. Ossicle status influenced postoperative results, especially in the presence of stapes. We also concluded that the indexes analyzed may help to predict the success of the surgery.     

Innovative transapical-transfemoral loop approach: First case of CoreValve implantation in a 19-mm Mitroflow during double valve-in-valve procedure

An 80-year-old woman with rheumatic valve disease and two previous cardiac surgeries was admitted for heart failure exacerbation. The patient presented stenotic aortic 19-mm Mitroflow and mitral 31-mm Carpentier-Edwards bioprostheses, and was deemed inoperable due to frailty and prohibitive surgical risk. The heart team decided on a compassionate double valve-in-valve procedure, with transfemoral implantation of a 23-mm aortic CoreValve Evolut R and transapical implantation of a 29-mm mitral Edwards SAPIEN 3. During the procedure, after extreme difficulty in retrograde crossing of the aortic valve, a transapical-transfemoral loop was successfully performed. The procedure was without complications and the patient was discharged in NYHA class II with normally functioning valves.     

Retrospective analysis of skin complications related to bone-anchored hearing aid implant: association with surgical technique,quality of life,and audiological benefit

Introduction

The bone-anchored hearing aid is an effective form of auditory rehabilitation. Due to the nature of the implant, the most common complications are skin related. A number of alternative surgical implantation techniques have been used to reduce the frequency and severity of skin complications, including the U-shaped graft and the linear incision.

The effects of transcatheter aortic valve implantation on cardiac electrical properties

IntroductionTranscatheter aortic valve implantation (TAVI) is associated with cardiac electrical disturbances. However, beyond the risks of pacemaker implantation, few studies have performed a detailed assessment of the effects of TAVI on several cardiac electrical properties.ObjectivesTo assess the frequency and type of electrocardiographic disturbances following TAVI, according to the type of prostheses and to assess predictors of these disturbances.MethodsWe performed a detailed retrospective analysis of all electrocardiograms in patients who underwent TAVI, before and after the procedure, at a tertiary center from August 2007 to October 2016. Patients with permanent pacemakers were excluded.ResultsWe included 182 patients (78±8 years; 56% female) and self-expanding prostheses (SEP) were implanted in 54%. Most patients (80%) were in sinus rhythm at baseline. After TAVI, 21% of patients developed new-onset atrial fibrillation and there was a significant increase in PR interval at discharge (186±41 ms vs. 176±32; p=0.003), which was not maintained after at six-month follow-up (181±35 ms, p=0.06). There was also a significant increase in QRS duration at discharge (129±28 ms vs. 114±25 at baseline p<0.0001), which persisted at six-months (122±28 ms, p<0.0001). New-onset left-bundle branch block (LBBB) was observed in 25% of patients. The depth of valve implantation was a predictor of new LBBB at discharge after multivariate analysis (OR 37.6, 95% CI 14.6–65.2, p=0.001).ConclusionsThe main electrocardiographic disturbances post TAVI were PR prolongation, increased QRS and new-onset LBBB. These disturbances were more pronounced in patients undergoing SEP implantation and tended to improve at six-month follow-up. The depth of valve implantation was a predictor of conduction disturbances.     

Evolução Tardia das Próteses Biológicas e Mecânicas em Posição Aórtica

BackgroundDespite constant improvement and refinement of the prostheses, the decision between mechanical and biological valves for aortic valve replacement is still controversial.ObjectiveTo compare outcomes of aortic valve replacement with bioprosthesis and mechanical prosthesis.MethodsThis was an observational, historical cohort study with review of medical records. A total of 202 patients who underwent heart valve replacement surgery between 2004 and 2008 were selected, with a mean follow-up of 10 years. The level of significance set at 5%.ResultsMean age of patients was approximately 50 years; most patients were male (70%). Overall mortality- and reoperation-free survival was significantly higher in patients with mechanical prosthesis (HR=0.33; 95%CI=0.13-0.79; p=0.013). No difference was found in late mortality between the two groups. On the other hand, the risk of reoperation was significantly higher in patients with bioprosthesis than mechanical prosthesis (HR=0.062; 95%CI=0.008-0.457; p=0.006). The risk of composite adverse events – stroke, bleeding, endocarditis, thrombosis and paravalvular leak – was similar between the groups (HR=1.20; 95%CI= 0.74-1.93; p=0.44). The risk of bleeding was significantly higher in patients with mechanical prosthesis (HR=3.65; 95%CI= 1.43-9.29; p = 0.0064), although no case of fatal bleeding was reported.ConclusionNo difference in 10-year mortality was found between the groups. The risk of reoperation significantly increases with the use of bioprosthesis, especially for patients younger than 30 years. Patients with mechanical prosthesis are at increased risk of nonfatal bleeding.     

Effect of grinding and polishing on the roughness and fracture resistance of cemented CAD-CAM monolithic materials submitted to mechanical aging

Statement of problem

The effect of clinical adjustments on the strength of cemented computer-aided design and computer-aided manufacturing (CAD-CAM) monolithic materials under aging challenge is unclear.

Hemodynamic and clinical performance of Solo stentless bioprosthetic aortic valves

Objective

To report the hemodynamic profile and short- and medium-term outcomes of Freedom Solo and Solo Smart stentless aortic valves implanted at our center.

A pregnant woman with a mechanical prosthetic valve

A 24-year-old woman who was 11 weeks pregnant and had a mechanical mitral valve presented at the emergency department with ischemic stroke. Although treatment with aspirin and unfractionated heparin was initially successful, subsequent management was almost impossible, as she eventually suffered a right hemispheric stroke, requiring percutaneous intervention and an emergency cesarian; prosthetic valve thrombosis with hemodynamic instability; and multiple bleeding complications. This case demonstrates how difficult it can be to select the appropriate treatment strategy for prosthetic valve thrombosis.