Infectious Diseases Society of America.

Antimicrobial prophylaxis in surgery

Antimicrobial prophylaxis for surgery: An advisory statement from the national surgical infection prevention project

Fourth universal definition of myocardial infarction. focus on the type 2 myocardial infarction

Highly impacting oral and poster presentations wherein new treatment modalities for coronary artery disease, heart failure and other common cardiovascular diseases were presented throughout the AHA Scientific Sessions 2012, including new developments in the area of lipid-modifying therapies that starred one of the high-impact late-breaking clinical trial sessions during the conference. A summary of the most relevant findings among the over 4,000 abstracts presented during the meeting are reported in the following report.

A report from the American Heart Association Scientific Sessions 2012 (November 3-7 - Los Angeles, California, USA).

We report a bail out approach of endovascular thoracic aorta repair following incorrect deployment of a modified frozen elephant trunk stent graft into the false lumen. A 76-year-old patient was admitted to our Emergency Department. A computed tomography angiography scan showed type I DeBakey aortic dissection. An emergency modified frozen elephant trunk procedure was performed. Immediate postoperative computed tomography angiography showed that the distal segment of the stent was deployed in the false lumen, probably through a re-entry tear at the descending thoracic aorta. Emergency endovascular repair of the thoracic aorta, as well as angioplasty of the superior mesenteric artery and left iliac artery, were performed.

https://journals.sagepub.com/doi/pdf/10.1177/0300060520986710

Simple endovascular thoracic aortic stenting rescues a wrongly deployed frozen elephant trunk during a modified procedure.

Postoperative common carotid artery occlusion after reconstruction for type A aortic dissection can lead to major neurological morbidity. Surgical strategy to re-establish the cerebral perfusion depends on the time of onset of neurological deficits in this otherwise life-threatening disease. We present two cases with neurological deficits after replacement of the ascending aorta for a type A dissection treated with two different surgical strategies. In both cases, prompt surgical interventions improved neurological outcome.

/pdf/two-different-cases-of-postoperative-symptomatic-common-2grdmnnw1a.pdf

Two different cases of postoperative symptomatic common carotid artery involvment in type A aortic dissection


 
 
 Circulating high sensitivity cardiac troponin T (hs-cTnT) levels are frequently elevated in patients with end-stage renal disease (ESRD). The underlying pathophysiology is largely unknown. Currently, accumulation of hs-cTnT due to impaired renal clearance, as well as increased production caused by chronic cardiomyocyte injury is being discussed.
 
 
 
 The aim of this study was to assess the relative contribution of impaired renal clearance as a non-cardiac source of elevated hs-cTnT concentrations, using renal transplantation as an in vivo model of rapidly improved renal function and on a short-term basis rather unchanged cardiac pathology.
 
 
 
 This single-centre study was a secondary analysis within a prospective active surveillance study program for perioperative myocardial infarction/injury (PMI). 42 consecutive high-risk patients undergoing renal transplantation without evidence of PMI were included. Serial creatinine and hs-cTnT (Elecsys, Roche) measurements were performed pre-transplant (baseline) and post-transplant on day (d) 1, between d2 and d5, and between d14 and d180. The effect of time and creatinine on hs-cTnT was estimated with a log-level non-linear mixed-effects model, where time and creatinine were treated as the fixed effects and subject as the random effect. Natural cubic splines were used to account for nonlinearity in the fixed effects.
 
 
 
 Baseline median serum creatinine concentration was 616 umol/L [interquartile range (IQR) 477–825], and significantly fell to 425 umol/L (IQR 313–619) on d1, 285 umol/L (IQR 194–509) on day2–5, and 116 umol/L (IQR 100–166) on d14–180 (p<0.001, p<0.001, and p=0.043, respectively; Figure 1A).
 Pre-transplant hs-cTnT concentrations were above the 99th percentile (14ng/L) in all patients, median hs-cTnT concentration was 50 ng/L (IQR 35–70). In parallel to the fall in serum creatinine from baseline to d1, hs-cTnT concentrations significantly fell to 28 ng/L (IQR 15–40) on d1 (p<0.001), and then remained constant on d2–5 (27 ng/L (IQR 18–35)), and on d14–180 (24 ng/L (IQR 19–28); Figure 1B).
 The mixed-effect model showed a significant decrease of hs-cTnT between baseline and d1 (p<0.001), whereas no significant change between d1 and d2 (p=0.82) occurred (Figure 2).
 
 
 
 In contrast to the continuously falling serum creatinine levels, hs-cTnT concentrations reduced by about 50% only within the first 24 hours with a functional graft and then remained elevated above the 99th percentile. This suggests, that ESRD is a non-cardiac source of elevated circulating hs-cTnT concentrations, which contributes about 50%, while the other 50% seem related to chronic cardiomyocyte injury. Further studies assessing the long-term effect of renal transplantation on hs-cTnT levels and cardiac function are needed.
 
 
 
 Type of funding sources: Public Institution(s). Main funding source(s): Swiss National Science FoundationSwiss Heart Foundation


/pdf/renal-failure-a-non-cardiac-source-of-high-sensitivity-qc23t5xh.pdf

Renal failure: a non-cardiac source of high sensitivity cardiac troponin T

Temporary extracorporeal femoro-femoral crossover bypass to treat acute limb ischemia due to occlusive femoral transaortic microaxial left ventricular assist device - A novel technique and case series.

Classic surgical thrombectomy of the aorta and iliac arteries through an incision in the groin vessels harbors the risk of embolization to the viscero-renal as well as hypogastric arteries, while percutaneous endovascular thrombectomy techniques can lead to peripheral embolization to the lower limbs. Therefore, we describe a novel, percutaneous technique that tackles the above issues. Furthermore, we also present our initial experience using the technique. The principle of the technique is to percutaneously place large-bore sheaths in the iliac arteries that deliberately occlude the latter to protect the lower limbs from embolization. Through one of these sheaths, over wire Fogarty® catheters can be placed and inflated in the ostia of the coeliac trunk, superior mesenteric artery, renal arteries, and hypogastric arteries as needed. A large thrombectomy balloon catheter is then used to bring any aorto-iliac thrombus into the sheaths, whereafter the thrombus is removed from the sheaths by simply deflating their valves. Additional endovascular procedures of the aorto-iliac branches can be performed as needed. We report nine procedures in 8 patients (4 males and 4 females) with a median age of 63 (53–68.5). Additional endovascular procedures were performed in 6 (66.7%) procedures. All but one procedure were technically successful, and all patients had palpable foot pulses on completion of the procedures, while no patient had clinical signs of peripheral embolization. This technique is a very valid addition to the vascular surgeon’s armamentarium when treating aorto-iliac thrombotic events because it is minimally invasive while still protecting against embolization and offering the flexibility to perform a wide range of additional endovascular procedures where needed.

/pdf/a-novel-percutaneous-technique-for-aorto-iliac-thrombectomy-3vvn1bmm.pdf

Edin Mujagic

Papers

Simple endovascular thoracic aortic stenting rescues a wrongly deployed frozen elephant trunk during a modified procedure.

Two different cases of postoperative symptomatic common carotid artery involvment in type A aortic dissection

Renal failure: a non-cardiac source of high sensitivity cardiac troponin T

Temporary extracorporeal femoro-femoral crossover bypass to treat acute limb ischemia due to occlusive femoral transaortic microaxial left ventricular assist device - A novel technique and case series.

A Novel Percutaneous Technique for Aorto-Iliac Thrombectomy without the Risk of Embolization