The Experts below are selected from a list of 1506 Experts worldwide ranked by ideXlab platform
Makoto Takinami - One of the best experts on this subject based on the ideXlab platform.
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role of Biologic Glue repair of proximal aortic dissection in the development of early and midterm redissection of the aortic root
The Annals of Thoracic Surgery, 2001Co-Authors: Teruhisa Kazui, Abul Hasan Muhammad Bashar, Kazuchika Suzuki, Katsushi Yamashita, Naoki Washiyama, Hitoshi Terada, Makoto TakinamiAbstract:Abstract Background . Redissection of the aortic root after supracommissural aortic graft replacement with reapproximation of the layers of the dissected aortic root is relatively rare. Causes and surgical treatment of this lesion remain controversial. Methods . From January 1983 to September 2000, 130 patients had emergency operation for acute type A aortic dissection. Of them, 57 patients underwent root reconstruction using Biologic Glues and 4 patients (7.0%) developed redissection of the aortic root associated with moderate to severe aortic regurgitation 5 to 27 months after the initial operation. In all patients, the proximal false lumen was obliterated with infusion of gelatin-resorcinol-formaldehyde (GRF) Glue or BioGlue and the aorta was reinforced with Teflon felt strip or Surgicel placed on its outside wall. Results . During reoperation, the noncoronary aortic sinus was found to be redissected in all patients with the dissection extending retrogradely to the aortic annulus. This resulted in aortic regurgitation with prolapse of the noncoronary cusp because the proximal suture line dehisced. Histopathology showed disappearance of the nuclei of the medial smooth muscle cells, suggesting tissue necrosis at the site of GRF Glue application. The lesions were treated successfully with full root replacement using a freestyle heterograft bioprosthesis or a composite graft prosthesis. Conclusions . The use of Biologic Glues for reapproximating the layers of the dissected aortic root is associated with a certain amount of risk of aortic wall necrosis. Therefore, care should be taken to ensure proper use of these Glues. Full root replacement could be a preferable technique for treating redissection of the aortic root.
Hironori Izutani - One of the best experts on this subject based on the ideXlab platform.
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Sutureless coronary artery bypass with Biologic Glued anastomoses: Preliminary in vivo and in vitro results
The Journal of thoracic and cardiovascular surgery, 2000Co-Authors: Steven R. Gundry, Kirby S. Black, Hironori IzutaniAbstract:Abstract Objective: As heart surgery becomes increasingly focused on minimally invasive techniques, it has become apparent that conventional techniques of anastomosis will need to be severely altered or abandoned. Toward that end, we developed and tested in vitro and in vivo coronary artery bypass graft anastomoses using a Biologic Glue formulated from bovine albumin and glutaraldehyde. We used a double-balloon catheter as a temporary internal stent to create and seal the anastomosis during gluing. Methods: Initially, anastomoses were made between cryopreserved human saphenous vein segments and coronary arteries in vitro on 12 intact bovine hearts. A total of 42 anastomoses were created with the catheter system introduced into the distal end of the graft, exiting the back wall, and entering the anterior wall of the coronary artery. Two balloons (one in the graft and one in the coronary artery) held the anastomosis stable while the Biologic Glue was applied externally and allowed to set for 2 minutes. The balloon catheter was then removed from the end of the graft simulating a side-to-side internal thoracic artery anastomosis. After the graft had been flushed to assure distal end patency, the open end of the graft was clipped, turning the anastomosis into an end-to-side graft. A pressure transducer was then attached to the graft and saline solution forcefully infused. Results: All grafts easily held a pressure of 300 mm Hg; 10 grafts were tested up to 560 mm Hg without leaks. Distal and proximal coronary artery patency was checked by examining flow out of the coronary ostia and by cutting arteries distal to the grafts. All anastomoses were patent on being opened and no Glue was seen intraluminally. Subsequently, 3 anastomoses of the left internal thoracic artery to the left anterior descending artery have been constructed in goats, with autopsies at 24 hours, 10 months, and 1 year revealing patent anastomoses. Conclusion: A Biologic Glue and catheter system has been developed that allows a coronary anastomosis with a high bursting strength to be performed. When the system has been further developed and tested, truly minimally invasive heart surgery may be possible. (J Thorac Cardiovasc Surg 2000;120:473-7)
Akio Ihaya - One of the best experts on this subject based on the ideXlab platform.
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adventitial inversion technique without the aid of Biologic Glue or teflon buttress for acute type a aortic dissection
European Journal of Cardio-Thoracic Surgery, 2005Co-Authors: Kuniyoshi Tanaka, K Morioka, Narihisa Yamada, Atsushi Takamori, Mitsuteru Handa, Sawaka Tanabe, Akio IhayaAbstract:Objective: This study was performed to evaluate the clinical usefulness of the adventitial inversion technique in acute type A aortic dissection, with special attention to the impact of this procedure on the postoperative status of false lumen evaluated by computed tomographic scan. Methods: From March 2001 to November 2004, 18 consecutive patients underwent emergent surgery for acute type A aortic dissection. Supracoronary graft replacement was performed in all the patients (ascending aorta/hemiarch replacement: 13/18 = 72%, total arch replacement: 5/18 = 28%). The adventitial inversion technique was used for both the proximal and the distal stump constructions of the dissected aortic wall without the aid of Teflon felt or Biologic Glue. Aortic regurgitation was treated with resuspension of the aortic commissures. Results: There were two hospital deaths and the overall hospital mortality rate was 11.1%. The mean postoperative blood loss was 635 214 ml and no reexploration was required in any of the patients. Postoperative computed tomography showed closure of the false lumen in aortic root, aortic arch, and proximal descending thoracic aorta in all of the surviving patients. Postoperative echocardiography demonstrated no aortic regurgitation in any of the patients. Two patients died late postoperatively from unrelated causes to aortic dissection. The remaining 14 patients aredoingwell withouta second-stage operation for aorticroot ordistal aorticlesions duringthe follow-up periodof7—51 months(mean: 28 14 months). Conclusions: The adventitial inversion technique provides an excellent immediate hemostasis and facilitates thrombotic closure of the proximal and the distal false lumen in the treatment for acute type A aortic dissection. # 2005 Elsevier B.V. All rights reserved.
Ibrahim Matter - One of the best experts on this subject based on the ideXlab platform.
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Minimizing Hemorrhagic Complications in Laparoscopic Sleeve Gastrectomy—a Randomized Controlled Trial
Obesity Surgery, 2015Co-Authors: Gideon Sroka, Daria Milevski, Dan Shteinberg, Husam Mady, Ibrahim MatterAbstract:Background Laparoscopic sleeve gastrectomy (LSG) has gained worldwide popularity in recent years. Hemorrhagic complications (HC) are usually the result of stapler line bleeding and are probably underreported. The previous incidence of HC in our department including minor bleeding and late hematomas was 15.0 %. The objective of this study is to assess the impact of stapler line reinforcement (SLR) and intraoperative blood pressure control on HC after LSG. Methods Between February 2013 and March 2014, patients who were admitted to our department for LSG were randomly assigned to one of three arms: stapler line application of Biologic Glue—Evicel™ (E), over suture of the stapler line (S) or control (C). Surgical technique in all arms included blood pressure elevation to 140 mmHg before termination of the procedure. Data is presented as mean ± SD or median (IQR 25–75). Results One hundred sixty-five patients were randomized: 49 to E, 49 to S, and 67 to C. There were no demographic differences between arms. Operative time was significantly longer in S than in E and C arms (74 ± 21 vs. 64 ± 23 and 54 ± 19 min, respectively). ∆Hb was significantly lower in the S group. Packed cells were used in two from E and one from C arms. Late infected hematoma occurred in three (1.8 %) patients: one from E and two from C arms. Leak rate was 1.2 %: one from S and one from C arms. LOS was the same. No patients were re-operated due to bleeding. Conclusions In this randomized trial, routine elevation of systolic blood pressure to 140 mmHg and over suture of the staple line in LSG minimized HC, with reasonable prolongation of the procedure.
Teruhisa Kazui - One of the best experts on this subject based on the ideXlab platform.
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role of Biologic Glue repair of proximal aortic dissection in the development of early and midterm redissection of the aortic root
The Annals of Thoracic Surgery, 2001Co-Authors: Teruhisa Kazui, Abul Hasan Muhammad Bashar, Kazuchika Suzuki, Katsushi Yamashita, Naoki Washiyama, Hitoshi Terada, Makoto TakinamiAbstract:Abstract Background . Redissection of the aortic root after supracommissural aortic graft replacement with reapproximation of the layers of the dissected aortic root is relatively rare. Causes and surgical treatment of this lesion remain controversial. Methods . From January 1983 to September 2000, 130 patients had emergency operation for acute type A aortic dissection. Of them, 57 patients underwent root reconstruction using Biologic Glues and 4 patients (7.0%) developed redissection of the aortic root associated with moderate to severe aortic regurgitation 5 to 27 months after the initial operation. In all patients, the proximal false lumen was obliterated with infusion of gelatin-resorcinol-formaldehyde (GRF) Glue or BioGlue and the aorta was reinforced with Teflon felt strip or Surgicel placed on its outside wall. Results . During reoperation, the noncoronary aortic sinus was found to be redissected in all patients with the dissection extending retrogradely to the aortic annulus. This resulted in aortic regurgitation with prolapse of the noncoronary cusp because the proximal suture line dehisced. Histopathology showed disappearance of the nuclei of the medial smooth muscle cells, suggesting tissue necrosis at the site of GRF Glue application. The lesions were treated successfully with full root replacement using a freestyle heterograft bioprosthesis or a composite graft prosthesis. Conclusions . The use of Biologic Glues for reapproximating the layers of the dissected aortic root is associated with a certain amount of risk of aortic wall necrosis. Therefore, care should be taken to ensure proper use of these Glues. Full root replacement could be a preferable technique for treating redissection of the aortic root.