PubMed Health⌕ Search

Biomedical subjects

A Juffe

Publications and source records attributed to A Juffe.

At least 19 recordsLinked to original sources
PubMed1998

Is the femoral cannulation for minimally invasive aortic valve replacement necessary?

INTRODUCTION: Minimally invasive cardiac surgery through a small transverse sternotomy is a new promising technique that can be considered an alternative in most cases to aortic valve replacement thus reducing surgical trauma and subsequent time of hospitalization. The need to avoid the risks associated with femoro-femoral bypass has lead to the interest in aortic valve replacement (AVR) operations without femoral vessels cannulation. We want to emphasize a few important points of our technique, which differs somewhat from the one applied by Cosgrove and associates. OBJECTIVE: This study details the approach to the minimally invasive AVR as first described by. Cosgrove et al. without standard femoral cannulation and points out our preliminary clinical experience. PATIENTS AND METHODS: From October 1996 to May 1997 we have operated on 25 patients using minimally invasive AVR (MI-AVR) In 23 cases, access through transverse sternotomy as described by Cosgrove et al., was performed. In two additional cases the chest is opened via a mini-median sternotomy with an 'L'-shape extending from the sternal notch to the superior edge of the third interspace. Twenty-three patients underwent AVR through transverse sternotomy. The male/female ratio was 13:10. The mean age was 67 years (range 45-78 years). Seventy-four percent of the patients were over 65. Predominantly, in 43% of cases aortic valve stenosis and in 25% of cases aortic valve regurgitation isolated is presented. In 19 cases, a 10-cm transverse incision is performed over the second interspace. Likewise, in four cases over the third interspace according to the thorax morphology and length of the ascending aorta assessed by chest X-ray films. By convention, cannulation of the ascending aorta and right atrial appendage was performed as usual. In contrast, in one patient (5.5%), cannulation was placed in the superior vena cava and right common femoral vein into the inferior vena cava. In the present series, 15 mechanical prostheses and eight bioprostheses whose used sizes were 19, 21,23, and 25 mm in diameter were placed in four, nine, nine, and one of the cases, respectively. All patients underwent AVR electively and a transesophageal echocardiography probe is made. RESULTS: During surgery, conversion to median sternotomy was not required in any patient. Mean aortic cross-clamp time was 68 min (range 38-90 min). Mean total bypass time was 87 min (range 50-120 min). Mean postoperative bleeding was 434 ml. (range 200-850 ml). Perioperative blood transfusion was required in 17% of the patients. Mean mechanical ventilation time was 7.3 h (range 3-24 h), with a mean ICU stay of 18 h. Mean postoperative hospital stay was 4.5 days (range 3-10 days). In all cases, transthoracic and transesophageal echocardiography were performed postoperatively Prosthetic valve dysfunction was not observed. On the other hand, just one patient (4%) died 5 days after operation due to sudden cardiac death. Further, in two patients (8%), during follow-up, pericardial effusion is detected. In one case, cardiac tamponade with hemodynamic instability required a pericardial window procedure. In addition, in two patients (8%), non-infectious sternal dehiscence required reinforced sternal closure. CONCLUSIONS: Minimally invasive AVR surgery without femoral vessel cannulation is a safe procedure with less surgical aggression. After a learning curve, benefits on fast-track programs will be accomplished.

Aged↗
PubMed1984

Long-term results of cardiac valve replacement with the Delrin-disc model of the Björk-Shiley valve prosthesis.

One hundred two Björk-Shiley valve prostheses with the Delrin-disc occluder were implanted in 83 patients between January, 1971, and July, 1972. Fifty-eight were in the mitral position, 42 in the aortic, and 2 in the tricuspid. Complete follow-up until 1981 was obtained in 93% of the patients (mean follow-up, 66.8 months). Hospital mortality was 18% and late mortality, 19%. Survival according to actuarial methods was 84.8% at 5 years and 78.1% at 9 years after operation. Thromboembolism was detected in 8.8% of patients but caused no deaths. The incidence was 1.2% and 1.5% per year in those patients treated with Coumadin and antiplatelet agents, respectively. Reoperation was necessary in 13% of the patients. Most survivors (72%) are in New York Heart Association Functional Class I, despite a preoperative status of Class III or IV in 57% of the patients. Hospital mortality may be due to poorer understanding of patient management and less refined techniques of myocardial protection. Long-term survival with this prosthesis is similar to that in more recent studies, and rates of thromboembolism and malfunction compare favorably with other prosthetic valves.

Adolescent↗
PubMed1982

Dysfunction of the Björk-Shiley prosthesis. Report of 32 cases.

We present 32 cases of dysfunction of the Björk-Shiley valvular prosthesis, representing 3.01% of the 1,063 BS prostheses implanted at this clinic. The complications observed were thrombosis of the prosthesis, suture dehiscence with or without endocarditis and disc-suture interference. In selected, favourable cases, we prefer thrombectomy with generous washing of the prosthesis and rotation of the disc, without removal of the disc from the prosthesis. Furthermore, when the dehiscence does not exceed 1/3 of the circumference of the ring, we have achieved very good results with single sutures supported on Teflon patches. Subsequent failures of this procedure were not of a technique nature, but rather due to the poor condition of the patients. In situations of clinical emergency, the diagnosis of valvular dysfunction may suffice as indication of surgery, further diagnostic measures being postponed in view of the data of the physical exploration.

Adolescent↗
PubMed1982

Thrombectomy: surgical treatment of the thrombosed Björk-Shiley prosthesis. Report of seven cases and review of the literature.

Among 1,000 patients with 1,225 Björk-Shiley prostheses, we have detected 12 cases (0.98%) of late thrombosis of the Prosthesis, seven of which were successfully managed by thrombectomy. A review of other authors' experience with this procedure shows no deaths directly attributable to thrombectomy, although two patients had cerebral embolization during the procedure. For prevention of this complication, we propose that both the aorta and the left atrium be explored during thrombectomy of either the mitral or the aortic prosthesis so as to achieve complete exposure of the left ventricular outflow tract and complete removal of any thrombus located in the ventricle. We consider this the procedure of tract and complete removal of any thrombus located in the ventricle. We consider this the procedure of choice in thrombosis of the Björk-Shiley prosthesis. Replacement of the prosthesis would then be restricted to cases of prosthesis damage or those in which adequate anticoagulation cannot be maintained.

Adult↗
PubMed1979

[Vascular approach for periodic hemodialysis. Clinical course of 100 internal arteriovenous fistulas (author's transl)].

The clinical course of 100 internal arteriovenous fistulas in patients observed over a period of more than 6 months was analyzed. Ninety-six were practiced in the upper extremities as side-to-side anastomoses in the forearm between the radial artery and the nearest vein; three were constructed in the lower limbs as anastomoses between the femoral artery and the internal saphenous vein; and one was an autograft of the saphenous vein in the forearm. The most important complications observed were thrombosis (arising chiefly from scant venous development, surgical procedures, and episodes of arterial hypotension), distal ischemia, distal venous flow, infection of the fistula, and insufficient flow. A blood flow over 350 ml/min was achieved in all except two patients. The actuarial survival of individuals with arteriovenous fistulas is high at the present time, with 86 percent of the fistulas functioning after 3 years. The longest period of satisfactory arteriovenous fistula function is 8 years and 3 months.

Acute Kidney Injury↗
PubMed1977

Prosthetic valve endocarditis by opportunistic pathogens.

The incidence of endocarditis produced by the so-called "opportunists" as a complication of prosthetic valve surgery is progressively increasing in frequency and gradually transforming the clinical picture habitually associated with this disease. We report six cases of endocarditis produced by opportunistic microorganisms (two cases by Candida, and the remaining by Serratia, Actinobacillus, Acinetobacter calcoaceticus, and Bacteroides fragilis, and by Corynebacterium diphtheriae) in four male and two female patients, making special comment on our findings, diagnostic criteria, and treatment. The patients' ages ranged from 9 to 54 years, and all six patients had long-term complications, with symptoms appearing between 45 days and four years after prosthetic valve surgery. The progressive increase of this new type of prosthesis infection is favored by the indiscriminate use of certain drugs and especially by the prophylactic use of antibiotics.

Adult↗
PubMed1977

Coarctation of the aorta and severe aortic insufficiency: What to repair first?

A new surgical approach is proposed for patients with coarctation of the aorta associated with severe aortic valvular insufficiency. The valvular lesion should be repaired first and the coarctation corrected during a second operation; both interventions should be done during the same hospital stay. We base our approach on the belief that improved coronary perfusion can be achieved when the aortic insufficiency is corrected first. The disadvantages of the opposite surgical approach, such as anticoagulation problems, renal underperfusion, and hypertensive complications are easily avoided.

Adolescent↗
PubMed1977

Cardiac valve replacement with the Björk-Shiley prosthesis in young patients.

Between 1971 and 1974, 26 valve replacements with the Björk-Shiley tilting disc valve prosthesis were performed in 23 children between 4 and 16 years of age. Mitral valve replacement was carried out in 11 patients, aortic valve replacement in 9 and double replacement in the other 3 patients. Several of the patients presented associated lesions which were also corrected at the same intervention, One patient died during the postoperative period; the remaining 22 all showed significant clinical remission. No incidents of thromboembolism or complications of any other nature were observed during follow-up periods of 6 to 26 months. It is our belief that the Björk-Shiley valve represents an improvement over other prostheses currently used for the surgical correction of valve disease in children.

Adolescent↗