Domenico Calcaterra

Real-World Outcomes of Hemostatic Matrices in Cardiac Surgery

OBJECTIVE While hemostatic matrices are efficacious in achieving hemostasis, outcomes research is limited; therefore, this study analyzed clinical outcomes of flowable hemostatic matrices in a real-world cardiac surgical population. DESIGN Retrospective database analysis of cardiac surgical cases from 2006 to 2012. SETTING Data were extracted from Premiers United States (US) Perspective Database, developed for quality and utilization benchmarking and containing approximately 25% of US hospital discharges. PARTICIPANTS Coronary artery bypass grafting (CABG), aortic, valve, or valvular with CABG surgery cases in which FLOSEAL or SURGIFLO was included. INTERVENTIONS Three study groups were formed, given usage of hemostatic matrices: (1) FLOSEAL or SURGIFLO, exclusively; (2) FLOSEAL or SURGIFLO, with fibrin sealants, sealants, or powder hemostats; and (3) FLOSEAL or SURGIFLO, with nonflowable hemostats with or without thrombin. Outcomes included complications, transfusions, surgical revisions, mortality, length of stay (LOS) and surgery time. MEASUREMENTS AND MAIN RESULTS Group A included 4,480 FLOSEAL and 326 SURGIFLO cases. Results suggested SURGIFLO cases were associated with significantly higher risk of multiple adverse outcomes, including major (odds Ratio [OR] 2.12; 95% CI 1.34-3.35; p = 0.001) and minor complications (OR 1.84; 95% CI 1.33-2.55; p<0.001); surgical revisions (OR 2.01; 95% CI 1.03- 3.94; p = 0.042); transfusions for any blood products (OR 4.90; 95% CI 3.50-6.87; p<0.001); and longer surgery times (adjusted mean difference = 64 minutes, p<0.001) than the FLOSEAL group. There were no significant differences in mortality and LOS. Results were similar in groups B and C. CONCLUSIONS These retrospective outcomes suggested FLOSEAL was associated with fewer negative consequences than SURGIFLO in this surgical population.

Ascending Aortic Graft Thrombosis and Diffuse Embolization From Early Endoluminal Aspergillus Infection

We present a 43-year-old man who underwent emergent replacement of the ascending aorta for type A dissection and hemiarch reconstruction with a 28-mm prosthetic graft. Dramatic neurologic symptoms, renal failure, and bowel ischemia developed on postoperative day 5. A computed tomography scan showed a large floating thrombus in the ascending aortic graft and massive peripheral embolization throughout the body.

Acute Mesenteric and Aortic Thrombosis Associated With Antithrombin Deficiency: A Rare Occurrence

Antithrombin is a potent inhibitor of the coagulation cascade exerting its primary effects on activated factors X, IX and II. It is the mechanism by which heparin and low-molecular weight heparin cause anti-coagulation. Deficiency of antithrombin presents as a hypercoagulable state, and may result in unexplained deep venous thrombosis, arterial thrombosis and systemic embolization.

Anterior chest ecchymosis from complicated descending thoracic aortic aneurysm

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Exposure of Difficult Left Hilum in Bilateral Sequential Lung Transplantation

— see front matter # 2011 European Association for Cardio-Thoracic doi:10.1016/j.ejcts.2011.03.043 Seventy-one-year-old female with symptomatic descending thoracic aortic aneurysm complicated by small periaortic hematoma (Fig. 1a). She was managed medically. Two days after admission she developed unusual physical finding of anterior chest ecchymosis (Fig. 2). Repeated CT-scan demonstrated remarkable worsening of periaortic hematoma (Fig. 1b). Patient underwent thoracic endovascular aortic repair.

Semiautologous repair for congenital discontinuous right pulmonary artery.

Left hilar exposure can be challenging during bilateral sequential lung transplantation, particularly in patients with idiopathic pulmonary fibrosis due to the overlying heart and limited space. We describe a cost-effective technique that has been used in off-pump cardiopulmonary bypass to retract the heart away from the left hilum, without causing hemodynamic instability, thereby allowing implantation of the left lung without the use of cardiopulmonary bypass.

An option for intraoperative placement of an intra-aortic balloon pump in patients with occlusive peripheral vascular disease.

Unilateral absence of a proximal pulmonary artery (UAPA) is rare and occurs in an isolated form or in the presence of other cardiovascular anomalies. There is a paucity of literature describing surgical correction of this anomaly. Most commonly, a primary anastomosis between the main and proximal right pulmonary arteries has been described. However, in cases of long-gap discontinuity, this can be difficult and may result in excess tension on the anastomosis, predisposing to decreased patency. We present a novel technique by which discontinuity in the right pulmonary artery (RPA) is surgically corrected in a semiautologous fashion using a main pulmonary artery (MPA) flap.

Treatment of Mediastinitis with Wound-Vacuum Without Muscle Flaps

FIGURE 1. The intra-aortic balloon pump is inserted through a 6-mm Intra-aortic counterpulsation therapy is unanimously recognized as a fundamental tool to support patients with cardiac failure in the preoperative and postoperative periods. The intra-aortic balloon pump (IABP) is routinely inserted through the femoral artery, but in many circumstances this option is not available in patients with occlusive peripheral vascular disease. Access through the upper extremities represents a possible alternative but is often cumbersome and exposed to a high incidence of complications. We present a technique of intraoperative insertion of the IABP through the innominate artery using a Dacron graft conduit tunneled to the skin above or below the right clavicle.

Technique of aortic root reconstruction using a new model of Dacron graft with prefabricated coronary branches.

Abstract  Wound vacuum may represent a new solution to the treatment of patients with mediastinitis. We herein present case reports of two patients with very serious deep wound infections of the sternum (mediastinitis) treated with wound vacuum without muscle flaps. The implications of this new modality of treatment are discussed.

Endovascular stent grafting of a complicated type B aortic dissection with approach through the innominate artery using a side-branch graft

AbstractAortic root reconstruction is a demanding surgical procedure still associated with a significant morbidity. Arguably, the most demanding aspect of the operation is reestablishing continuity between the prosthetic graft replacing the aortic root and the coronary arteries. With the objective of simplifying the possible challenges of coronary reimplantation, we designed a new model of aortic root graft with prefabricated coronary branches. We used this technique in 8 patients (6 males, 2 females; mean age, 54 years). There were 6 modified Bentall procedures and 2 valve-sparing root replacements with the “reimplantation” technique. There was no mortality or morbidity related to the use of this new prosthetic graft. Our purpose was to report in detail the technique of aortic root reconstruction using this new graft with prefabricated coronary branches. The use of this graft may simplify the procedure and offer a valuable tool for aortic root reconstruction in cases where the reimplantation of the coronary buttons may represent a technical challenge.